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A TREATISE ON THE DISEASES AND 
DEFORMITIES OF CHILDREN. 



BY GEORGE S. STEBBINS, M. D. 

GRADUATE OF BERKSHIRE AND BOTTDOIS MEDICAL COLLEGES ; 

FELLOW OF THE MASS. MEDICAL SOCIETY; AND LATE A. A. SURGEON 

U. S. A. GENERAL HOSPITAL, WASHINGTON, D. C. 



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ILLUSTRATED. 



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A< Mnn, perhaps, the moment of his breath 
Receives the lurking principle of death ; 
The j-oniie; disease, that must subdue at lencrth, 
Grows with his growth, and strengthens with his .-: 




SPRINGFIELD, MASS : 
D. E. FISK AND COMFANY. 






Entered according to Act of Congress, in the year 1S73, by 

D. E. EISK & CO., 
In the office of the Librarian of Congress at 'Washington. 



CHA8. VAN VLACK, JAS. B. RODGER9 CO., 

ELECTROTYPER, BOOK AND JOE PRINTERS, 

SPRINGFIELD, MASS. 1'ULLADELPHIA. 



PREFACE. 

From the earliest dawn of human existence, through 
infancy and childhood, there is one continual succession of 
dangers to life and limb, some of them beyond human con- 
trol ; more of them as a result of unpardonable ignorance 
and carelessness. It is for the purpose of pointing out these 
many evils of youthful years, and directing attention to the 
remedies therefor, that the Author has given this work to 
the public. 



NOTE. 

Believing that the Ignorance of Parents and the 
Frivolities of Fashion destroy more lives than War and 
Pestilence, and hoping that some may be induced to study 
how to perpetuate a life that may not only prove a blessing 
to them in their declining years, but a benefactor to all 
mankind, we are prompted to bring out the author's work, 
trusting it will meet with an immense sale, and gladden the 
hearts of many a Home. 

PUBLISHERS. 



INFANTILE MORTALITY. 



Medical men are well aware of the fact that 
the mortality in early life, far exceeds that of 
any other period, but its great excess, is not as 
well known to the general public. 

In many of our larger cities it reaches 50 per 
cent, while in some it exceeds it. Dr. Playfair 
of London says, that out of 50,000 illegitimate 
children born annually in England, 30,000 per- 
ish before the end of the first twelve months. 

Mr. Walpole, Home Secretary underDisraeli's 
government, says the mortality among the 
poorer classes often reaches 80 or even 90 per 
cent. This dreadful mortality he declares to be, 
what is generally the case, the result of igno- 
rant, rather than criminal negligence. Here in 
our own country, the records do not show a 
much more favorable result in some of the larg- 
est cities. Through the kindness of the follow- 



8 INFANTILE MOETALITT. 

ing gentlemen, I have received reports from 
some of the principal cities, giving an accurate 
statement of the death rate among children un- 
der five years of age. 

Owing to purer air, better sanitary conditions, 
and more general attention to hygienic rules, 
the mortality of early life in the country and 
sparsely populated villages, is much smaller. 

N. A. Appollonia, City Registrar of Boston, 
reports the whole number of deaths in that city 
for 1871 to be 5888, of which number, there 
were 2395 children under five years of age. 

J. W. Russell, Secretary of the Board of 
Health of Chicago, reports the whole number of 
deaths in the city for two months after the fire, 
to be 1045, of which number, 458 were under 
five years of age. 

Samuel Smith, City Clerk of Worcester, re- 
ports the whole number of deaths in that city 
for 1871 to be 1193, one-half of which were 
children under five years of age. 

The City Clerk of Fall River, reports the 
whole number of deaths for 1871 to be 681, of 
which, there were 388 under five years of age. 

Dr. Chas. P. Russell, Register of Records of 
New York City, reports the whole number of 
deaths in that city for 1871 to be 26,976, of 



INFANTILE MOETALITY. 9 

which number there were 12,971 under five 
years of age. 

D. W. Mohler, Secretary of the Board of 
Health of the City and Port of Baltimore, re- 
ports the whole number of deaths in 1871 to be 
7141, of which, there were 3456 under five 
years of age. 

Dr. S. C. Bussell, Secretary of the Board of 
Health of New Orleans, reports the whole num- 
ber of deaths for 1871 to be 6059; under five 
years of age, 2124. 

From these several reports, taken from differ- 
ent parts of the country, it will be seen that 
the mortality of infantile life, amounts to from 
40 to 50 per cent, in the populous cities. It is 
probable that in the rural districts, the mortality 
would not average more than 25 per cent, or 
half the above rate. The greatest number of 
deaths was caused by scarlet fever, cholera in- 
fantum, and diseases of the digestive organs and 
nervous system. The number of still born chil- 
dren reported is surprising, and the question 
might well be raised, is it necessary, or is it not 
partially within the control of the parents and 
accoucher? 

It is a well known fact, that there is every 
year a large number of deaths among infants 



10 INFANTILE MORTALITY. 

under one year of age, resulting entirely from 
ignorance, the parents, or persons having them 
in charge, not knowing what is proper diet, how 
to properly clothe them, and how to guard 
against disease. Slight derangements of func- 
tion in infancy, particularly of the digestive and 
nervous systems, lead to serious consequences, 
and often to rapidly fatal results, hence the need 
of information concerning them, their nature, 
and how to remedy, or prevent them. 



STILL BORN CHILDREN. 



In" the great majority of cases, infants are 
able to breathe without much difficulty, as soon 
as they are born, but it often happens that they 
are born apparently dead, in which case, prompt 
and skillful measures of relief, on the part of 
the persons in attendance, are called for, in or- 
der to remove the hindrances to respiration, and 
to restore life. 

The most frequent causes of this condition 
are, natural feebleness of constitution, to that 
degree that the infant is unable to make the 
muscular exertion necessary for the commence- 
ment of breathing ; or, there may exist some 
obstruction to the flow of blood through the 
cord during labor, as when the cord is twisted 
around the child's neck or other part of its body ; 
by separation of the after-birth from the womb 
before the child is born, or by the presence of 



12 STILL BOEN CHILDEEN. 

mucus in the mouth and throat, preventing the 
entrance of air into the lungs. In cases of still 
birth arising from natural feebleness of constitu- 
tion, loss of blood, &c, the limbs of the infant 
will be relaxed and motionless, the skin cold, 
pale and sallow, the lips flaccid, the lower jaw 
fallen, and the pulsations of the cord so feeble 
as hardly to be felt. The infant may make an 
effort to cry, but from want of strength falls 
into a state of apparent death. In other cases, 
where the brain is congested by the flow of blood 
through the cord being hindered, the face will 
appear purple and bloated, the body hot and 
swollen, the limbs full and flexible, and the pul- 
sations of the cord full and strong. 

In all cases of still birth, so long as the heart 
continues to beat, there is good hope and pros- 
pect that breathing can be established, and per- 
severing attempts should be kept up for an hour 
or two, for new born children are quite tenacious 
of life, and many cases seemingly hopeless, have 
been saved. 

Now, having given the causes, and general 
appearances of a still born infant, the question 
arises, how shall one proceed to remove the dif- 
ficulty. In the first place, in treating this affec- 



STILL BORN CHILDREN. 13 

tion, the degree of asphyxia, or difficulty of 
breathing, must be taken into account. 

In the less advanced cases of apparent death, 
in which the child does not breathe just after 
birth, but either moves or presents a natural, 
healthy rate of pulse in the umbilical cord, and 
the heart, with blueish red color of the skin, 
Braun recommends instant production of respi- 
ratory movements. This is best accomplished 
by removal of the mucus present in the mouth 
and throat, with the feather of a quill, or with 
the little finger ; by setting the child on its feet, 
or by laying it on its side, with the mouth turned 
downwards ; by exciting reflex muscular move- 
ments, with dashing cold water on the face and 
breast, covering the body with a warm flannel 
wrapper, and rubbing the whole back gently 
with flannel. 

By thus exciting the skin, a very deep and 
strong inspiration, or drawing in of the breath 
takes place, followed by a hardly noticeable ex- 
piration. These movements are repeated at in- 
tervals of some seconds, or minutes ; the pulsa- 
tions in the umbilical cord hereupon stop, and 
the contractions of the heart continue rapidly. 
After the cord ceases to pulsate, it should be 
tied and divided, the child should be wrapped 
■ 2 



14 STILL BORN CHILDREN. 

in warm flannel or other clothing, laid on a pil- 
low, and allowed to rest for some time, during 
which breathing generally becomes rapid and 
free. 

But if one cannot succeed with the child still 
attached to the after-birth, in bringing about 
breathing by stimulating the skin, and if the 
heart's action becomes unnaturally slow, the cord 
must be cut, the infant put quickly into a warm 
bath, sprinkled while in this, with cold water, 
and after a few seconds, when the countenance 
appears natural, rubbed in warm wrappings. 

In the higher degrees of apparent death, in 
which the skin appears blue or pale, warm or 
cold, and no trace of motion, breathing, pulsa- 
tion of the cord, or movement of the heart can 
be made out, the cord must as quickly as possi- 
ble be severed, all the mucus in the mouth re- 
moved, the child laid on a pillow, and listen to 
observe the sounds of the heart. If the sounds 
of the heart are very weak and slow, the action 
of the organ must be aided by the introduction 
of air 'into the lungs, without wasting time in 
stimulating the skin, for nothing removes this 
state of the heart so rapidly as the entrance of 
atmospheric air into the lungs. This forcing of 
air into the lungs, is done either from mouth to 



STILL BORN CHILDREN. 15 

mouth, the nostrils being left unstopped, the 
mouth of the blower being protected from the 
mucus which escapes from the infant's nose, by 
a towel laid over the upper lip of the child. 
The hand resting on the chest or belly, must 
make slight pressure after each introduction of 
air, so as to imitate the expiratory movement 
of breathing. As soon as breathing is partially 
established, and the pulsations of the heart have 
become more frequent, the blowing in of air 
must be omitted for some minutes, and stimu- 
lants be applied to the skin. These are such as 
tickling the mouth, nose, palate, and soles of 
the feet, with a feather, rubbing the skin, plac- 
ing the infant first in warm, then in cold water, 
wrapping in hot clothes, applying substances 
with a powerful smell to the nose, as ammonia, 
brushing over the temples and pit of the stomach, 
with oil of mustard, &c. 

If a rattling sound persists after breathing 
has commenced, there is more or less mucus ob- 
structing the air tubes, and syrup of squills, or 
syrup of ipecac, may be given every half hour 
or less, until vomiting ensues. 

Infants who have been restored to life by 
these means are very weak, and sometimes re- 



16 STILL BOEX CHILDKEN. 

main unable to swallow, in which case refresh- 
ing or nourishing articles that are given, should 
be administered through a narrow tube, with the 
infant in an upright position. Every child that 
is (to all appearance) still born, must be put 
into a warm room or bed, and watched till 
rigidity of the muscles, and other positive evi- 
dences of death are noticeable. 

Several cases are on record, where infants ap- 
parently still born, were 'laid on the window 
seat, in a corner of the room, or other conven- 
ient place, awaiting a convenient time for re- 
moval and burial, who were found some time 
afterward, on examination, to be breathing 
quietly, and complacently sucking their thumbs. 

Infants who have been apparently dead for 
an hour or two after birth, have been restored 
to life by the application of electricity ; there- 
fore, prompt, patient, persistent effort is called 
for in dealing with still born children, for the 
life of the child depends upon the proper reme- 
dies, promptly applied. 

When we consider the great danger that ex- 
ists, and how often the remedies afford perfect 
relief, and save life, how important it appears 
that every mother should be made perfectly fa- 



STILL BOKtf CHILDREN. 17 

miliar with every method of treating children 
in emergencies like these, since she may be so 
situated as to direct others, in her own case, or 
that of a relative or friend. 

2* 



WASHING THE CHILD. 



It is often the case that young mothers are 
not very well informed upon this point, and 
therefore, a few rules for their guidance will not 
be out of place. The object in washing a child 
as soon as it is born, is, to remove all impurities 
from the surface of the body, that the infant 
brings with it from its mother's womb. The 
principal impurity attached to the skin, much 
resembles soft fat, adheres closely to the skin, 
and is quite difficult of removal. When this 
substance is not well cleansed from the body, and 
is allowed to remain for some time, it may give 
rise to a disagreeable odor, and it also dries and 
hardens, so as to cause pain from the mechani- 
cal irritation of the skin produced thereby, 
and sometimes produces redness and excoriation 
of the skin beneath. For these reasons it is de- 
sirable that the body of the infant should be 



WASHING THE CHILD. 19 

thoroughly cleansed, at the first washing. In 
order to render the operation of cleansing the 
skin easier, the following course may be pursued. 
Before washing the infant, rub the body thor- 
oughly with melted fresh lard, or warm sweet 
oil ; then carefully wash with luke warm water 
and soap, and use a piece of soft flannel or sponge, 
instead of cotton or linen. Special care should 
be exercised, to see that all this substance is 
completely removed from all folds of the skin, 
particularly about the joints, groins, armpits, 
neck and scrotum, that no soreness and chafing 
may folloAv; and during the whole process of 
washing, the infant should not be exposed to 
currents of air, and in cool weather should al- 
ways be dressed by a fire. 



DRESSING THE CHILD. 



The dress of the infant should be made com- 
fortable, rather than to conform to fashion. It 
should well protect from cold, without producing 
too great warmth of body, and should be so ar- 
ranged as to guard against too much pressure 
and restraint. It is a common practice to swathe 
a child up tight, with its head fixed, legs stretched 
out full length, and muffled up so close as to be 
unable, almost, to see or breathe, or move a 
limb ; in fact, they are fixed in regular order 
for a " good laying out." 

It can be dressed warm, and still be allowed 
to exercise its limbs, and see and breathe freely, 
without any danger arising therefrom. It is 
this freedom of movement of the limbs, and full 
exercise of its functions, that gives to the infant 
perfect development, health and strength. In 
cool weather especially, flannel must form a part 



DRESSING THE CHILD. 21 

of the infant's clothing, particularly their shirts 
and petticoats, and the flannel should be of fine 
and light quality, so as not to oppress by its 
weight and thickness. The flannel should be of 
the white kind, as it not only looks better, is 
finer and softer, but shows the dirt quicker, so 
that the garments will be likely to get a more 
frequent washing, an important consideration 
regarding children's underwear. It is a very 
common idea, that flannel can be worn a much 
longer time without doing mischief by its filth 
than any other fabric, but such is not the case, 
because flannel from its very texture is capable 
of absorbing the perspiration of the body, and 
will do so in such quantities, and to such an ex- 
tent, that if worn long enough, it becomes very 
offensive and unhealthy. The great advantage 
of flannel as a dress for infants in cool weather 
is, that it prevents the escape of heat from the 
body, by its non-conducting properties. The 
warmth of the infant's dress needs to vary more 
or less, with the variation of the temperature. 
The younger the child is, as a rule, the more 
flannel will be required, but it never should be 
used in quantities sufficient to excite perspira- 
tion. Another benefit of flannel is, that it pro- 
tects the body from sudden reductions of tern- 



22 DRESSING THE CHILD. 

perature, and it guards the body against the 
cooling effects of evaporation, and by prevent- 
ing its too sudden escape, it keeps a good por- 
tion of heat constantly applied to the skin by 
means of this vapor, and thus prevents it leav- 
ing the body too rapidly. 

At times, and under certain circumstances, 
flannel becomes an improper article of dress for 
infants, as when it excites too much perspira- 
tion, which is sometimes the case in the warmest 
weather of summer. When this is the case, the 
garments may be made of linen or muslin, tak- 
ing care to increase the clothing as the temper- 
ature lowers. Not unfrequently flannel irritates 
or poisons the skin, so as to produce an erup- 
tion, and an almost intolerable itching, and when 
this condition of the skin is noticed, flannel, if 
worn at all, should be worn over cotton, linen 
or muslin, so as to duly protect the skin. 

The belly band is an important appendage to 
the infant's dress, and should be made of flan- 
nel, of one thickness, cut bias, and should be 
worn from four to six months, or longer if the 
child is unusually feeble. The great object of 
the belly band is to properly support the belly, 
and especially the navel, so as to prevent rup- 
ture, or protrusion of the bowel and its cover- 



DEESSIKG THE CHILD. 23 

ings, at this point. It should not be applied too 
tightly, as it thereby increases the liability of 
rupture, by pressing or squeezing the contents 
of the belly together too forcibly. Infants' pet- 
ticoats for fall, winter and spring wear, should 
be made of flannel, and long enough to cover 
their limbs. After the child is eight or nine 
months old, its clothes should be shortened, so 
as to leave the feet and ankles free ; by this 
means the infant will use its limbs much earlier, 
although it is a bad practice to force children 
too much in learning to walk, before the limbs 
are firm enough to afford perfect support, as 
"bow-legs" are not particularly attractive. 

It is of the utmost importance that the feet, 
legs, and chest of infants, should be kept warm, 
and dry, at all seasons of the year. The infant 
should be kept clean, as well as dry, and this in- 
volves frequent changing, washing and drying 
the diapers. This allowing the infant to go wet 
for half an hour or more, for sake of conve- 
nience, is a heathenish custom, and should not 
be practiced. Every time a child is allowed to 
go wet, it is liable to take cold ; besides, it pro- 
vokes inflammation of the skin, and chafings, 
which make the child uneasy and fretful, as it 
has a perfect right to be under such circum- 



24 DRESSING THE CHILD. 

stances. If by means of such neglect, the 
child's groins or scrotum become inflamed, re- 
lieve its misery by sprinkling thereon some dry 
powder like powdered chalk, tannin, lycopo- 
dium, &c. 



NURSING. 



The mother's milk is the best, as it is cer- 
tainly the most natural food for infants, and when 
it is possible mothers should always nurse their 
offspring, instead of attempting to bring up their 
children in some other way less troublesome to 
them. The new born infant should be allowed to 
nurse every two hours during the day, and once 
or twice during the night. If the mother be 
weakly, instead of nursing the child during the 
night, cow's milk diluted one-half, or two-thirds, 
with water, and sweetened with sugar, may be 
substituted. It occasionally happens that women 
have their courses during the period of nursing, 
in whioh case the mother should feed the child 
during the flow, and if, as it sometimes happens, 
a woman becomes pregnant, or in other words, 
in a family way, while nursing, the child should 
be weaned, for if the child nurses under these 

3 



26 NURSING. 

circumstances, it will be liable to have diarrhea, 
colic, convulsions and the like. 

In many cases there is scantiness of milk, so 
that the mother affords the child but insufficient 
nourishment, and if the secretion of milk can~- 
not be increased, the child must be fed occasion- 
ally. 

One cause of scanty secretion of milk is a life 
of privation and toil, in which case, the infant 
is kept for too long a period from its mother's 
breast. Age, atrophy, or wasting of the breast, 
also lessens the supply of milk. 

There are practices, and remedial measures, 
that will often increase the secretion of milk, 
among which are, the frequent putting of the 
child to the breast, the application of electricity 
to the breasts, the castor oil plant applied to the 
breast in shape of a poultice, and the oil of the 
same plant taken internally. Oat meal and 
other gruels, ale and porter, are all good to in- 
crease the secretion of milk. The frequency 
with which a child needs to nurse depends much 
upon age, quantity of milk, &c. As a child grows 
older, it does not need to nurse as often, but it 
should be confined to breast milk till the seventh 
or eighth month, or till teeth begin to appear, 
when it may be feci with a little light food, such as 



NURSING. 27 

cracker in milk, a little soft boiled rice, wheaten 
flour, or canna farina, cooked in milk, soft boiled 
or baked potatoes, mashed and seasoned. 

It frequently happens that mothers cannot 
nurse their infants, and it becomes necessary 
to procure a wet nurse, but in selecting one, 
there are several things to be taken into con- 
sideration. In the first place, she should be free 
from all diseases, or special tendencies thereto, 
such as scrofula, consumption, and syphilitic taint 
of constitution. It is better that she should 
have nursed a child before, and also, that she 
should be young, of a healthy, vigorous consti- 
tution, of temperate habits, pleasant, Cheerful 
disposition, skin and complexion clear and free 
from eruptions, firm breast and well formed nip- 
ples, and an abundance of milk. It is frequently 
the case, that mothers and wet nurses find, when 
the child is three or four months old, that they 
have not milk enough to properly nourish the 
child ; when such is the case, the infant may 
begin to take a little cow's milk, of good qual- 
ity, diluted one-third with water, and sweetened 
with sugar. 

An infant of four months may be allowed 
small quantities of barley flour water ; the bar- 
ley flour can be obtained in small packages, is 



28 NURSING. 

to be boiled, and a very thin gruel made, to 
which milk may be added after it has boiled, 
and more solid food may be given as the infant 
advances in age and strength. 



WEANING. 



The proper time for weaning depends much 
upon circumstances, but as a general rule, it 
should take place at about the end of twelve 
months, or at any rate, from that to eighteen 
months. 

The infant should for a while preceding, be 
allowed some artificial food, and be accustomed 
to take drink from dishes, and at the same time 
be allowed the breast less and less frequently. 
Too much food should not be given the child, 
soon after weaning, and all food given should be 
of a liquid or semi-fluid form, as the infant can- 
not readily digest solid food at this time ; but 
after a while, boiled rice, sago, tapioca, gruels, 
beef tea, &c, may be given. 

If it can be avoided, infants should never be 
weaned during the hot months of summer, for 
the reason that diarrhea, and various other in- 



30 WEANING. 

fiammatory affections of the stomach and bowels, 
are apt to result. In the latter event, change 
of air and location, from city to country, should 
be made, as it is one of the best and surest 
remedies for the difficulty. 



THE NURSERY. 



Seeing that the greater portion of infantile 
life is spent in the nursery, it is of great impor- 
tance that the room should be well adapted to 
the tender age of the infant. The rooms should 
be large, high, and airy, capable of being thor- 
oughly ventilated, without unduly exposing the 
inmates to direct currents of air. If possible, 
the rooms should be on the south side of the 
house, and where sunlight can be readily and 
freely admitted. 

The importance of sunlight, and its effects 
on the health and physical well being of chil- 
dren, is very greatly undervalued. The nur- 
sery should never be used as a sleeping room, 
and should not be filled with trash that is not of 
special use in the room. 

Strict personal and domiciliary cleanliness, 
should always be observed in this department 



32 THE NURSERY. 

of the house, even if it becomes necessary to 
neglect others. 

In exercising parental authority over this de- 
partment, it is better to rule with patience, 
cheerfulness, and firmness if need be, than to 
rule with fretfulness, cross words, an ugly tem- 
per, and the rod. Use no language, and com- 
mit no deeds, in the presence of a child a year 
or two old and older, that }-ou are not willing 
the child should repeat and reenact, for remem- 
ber, that the habit of observation, and the 
power of imitation, develops early and remark- 
ably. 



TEETHING. 



Childeen are provided with two sets of teeth, 
which make their appearance at different times 
of life, and these two sets are called according 
to their duration, temporary and permanent. 

The temporary set consists of twenty in num- 
ber, and the time of their appearance is usually 
about as follows : The eruption of the teeth be- 
gins about the seventh month, and is complete 
about the end of the second year, those of the 
lower jaw appearing first. The different teeth 
of the temporary set appear in the following 
order : 7th month, central incisors ; 7th to 10th 
month, lateral incisors; 12th to 14th month, 
anterior molars; 14th to 20th month, canine 
teeth ; 18th to 30th month, posterior molars. 

The eruption of the permanent set takes 
place in the following order, and they are thirty- 
two in number : 6£ years, first molars ; 7th 



34 TEETHING. 

year, two middle incisors ; 8th year, two lateral 
incisors; 9th year, first biscuspid ; 11th year, 
second biscuspid ; 11th to 12th year, canine 
teeth; 12th to 13th year, second molars; 17th 
to 21st year, wisdom teeth. While the general 
order of the appearance of the teeth is as" above, 
there is often quite a variation from this rule in 
individual cases. 

The disorders which teething gives rise to are 
many and varied ; some children, however, have 
little or no trouble, during the whole period, 
but these are certainly fortunate, and excep- 
tional cases. 

Before the tooth presses through the gum, 
the latter is hot and swollen, the saliva flows 
more freely, the child is fretful, thrusts every- 
thing into its mouth that it can lay hands on, 
sleeps but little at night, its appetite fails, and 
there is often vomiting and diarrhea. 

At other times, in difficult cases of teething, 
children will be attacked with convulsions, owing 
to the great nervous irritation produced by the 
painful pressure of the tooth upon the gum. 

Paralysis, is another serious trouble sometimes 
caused by teething, and various derangements 
of circulation of blood through the brain and 



TEETHING. 35 

lungs, are attributable to the same cause ; also 
skin diseases with various forms of eruption. 

In considering the plan of treatment, the 
condition of the gums is to be carefully looked 
after, and the different derangements treated as 
they arise. 

Rubber and ivory rings are useful for children 
to have, for, by holding and biting them, they 
will gradually work the teeth through by the 
pressure of the gums upon them. 

Sometimes it may be wise to lance the swollen 
gums, but not as a general rule, and, in fact, had 
better be avoided when any other means will 
suffice, for it often gives rise to more irritation 
than it relieves. The nervous irritation is often 
so great as to require anodynes, as cold applied 
to the head, a few drops of elixir paregoric, val- 
erian, three or four grains of bromide of potassi- 
um, repeated three or four times a day, in a lit- 
tle water. In convulsions, it is well to give a 
warm bath, apply cold to the head, and give 
something to act freely upon the bowels. Where 
there is much vomiting or diarrhea, means must 
be resorted to to check these disorders. A little 
lime water and bismuth, or oxalate of cerium, 
dissolved in water, will often quiet the vomiting, 
and a little chalk mixture and magnesia, or 



36 TEETHING. 

fluid extract of rhubarb and magnesia, the diar- 
rhea. 

If paralysis ensues, constitutional treatment, 
stimulating lotions applied with friction and 
electricity, may be required to hasten its removal. 

The disorders of second teething are not gen- 
erally severe, although in some cases, severe 
coughs, spasms, St. Vitus dance and diarrhea, 
are present. The disorders may be much the 
same in kind as those of first teething ; but vary 
much in intensity, and call for more active meas- 
ures of relief. It is always best to watch the 
child carefully during the whole teething pe- 
riod, and anticipate the difficulties, and so be 
prepared to meet, and remove them as they 
arise, and remember that much needless suffer- 
ing comes through heedlessness and neglect. 



PROPER FOOD FOR CHILDREN AFTER 
FIRST TEETHING. 



It is too often taken for granted that a child, 
after being weaned, can with propriety and safety 
eat almost anything that any one can, while the 
fact is, great care is necessary in selecting the 
child's diet for. some time afterward. 

The sudden transition from liquid to solid food, 
and the increased taxation of the digestive pow- 
ers caused thereby is productive of great evil, 
and is a fruitful source of disease. Food must 
be given, simple in its nature, nutritious, easily 
masticated and digested, and the meals must be 
oft repeated, but with system and regularity. 
Simple articles of diet at first, like the following, 
will answer : Boiled rice, boiled wheaten flour, 
cooked in milk, jellies of sago, tapioca and arrow- 
root, and corn starch. After a time animal 
broth may be given, such as beef tea, chicken 

4 



38 PROPER FOOD FOR CHILDREN. 

broth, oyster broth, mutton broth, or a little of 
the meat itself cut up fine may be allowed. 

Do not think, as some people seem to, that a 
child's stomach can tolerate, or at least, digest, 
without disturbance, goose, veal, pork, bacon, 
duck, sausage, sour krout, boiled cabbage, Bo- 
logna sausage, cheese, mince pie, &c. 

Fresh fish, soft boiled eggs, fresh beef, in small 
quantities, agree well with children ; and when 
children get most of their teeth, solid food, as 
meats and vegetables, may be given in proper 
quantities. Of vegetables, potatoes, squash, as- 
paragus, are good, and the fresh ripe fruits, 
cooked apples, &c. Some fruits and vegetables, 
such as beans, peas, onions, cucumbers, pine ap- 
ples and peaches, had better not be given to 
young children. 

For drinks, pure cold water, or milk and water, 
or pure milk, are the best. Tea and coffee, 
wine and liquors, used to any extent by young 
children, are improper and injurious, unless it be 
necessary to resort to them for medicinal pur- 
poses. 

If due attention is given to the diet, dress, 
exercising, and cleansing of children, there will 
be comparatively little danger of their falling 
victims to disease ; on the other hand, neglect of 



AFTER FIRST TEETHING. 39 

these sanitary measures, will surely be followed 
with more or less disastrous consequences to 
health and life, and in fact, it is this very neglect, 
that almost beyond computation, increases the 
mortality of infantile life. 



DIAGNOSIS OF INFANTILE DISEASES. 



In attempting to ascertain what the particu- 
lar disease is from which a child is suffering, one 
must needs take careful observations of the gen- 
eral look and appearance of the child, as- for 
instance, the appearance of the countenance, of 
the eyes, mouth, gestures, position, sleej:>, cry, 
skin, temperature of the body, breath, circula- 
tion, discharge by vomiting and stool. In order 
that the importance of these may be better 
understood, they will be considered separately, 
and somewhat in detail. . 



THE COUNTENANCE. 



It is not uncommon for infants to have a yel- 
low, jaundiced condition or color of the skin for 
some weeks after birth, and it is said to be owing 
to the effect produced on the circulation of the 
blood through the liver, by the tieing of the 
umbilical cord ; but from whatever cause, it 
soon passes away, in most cases, without much 
trouble. 

The face also presents a livid appearance awhile 
after birth, owing sometimes to the mode of de- 
livery ; but when the lividity of the counte- 
nance comes on after exercise, in a child other- 
wise healthy, it indicates malformation, or im- 
perfection of the valves of the heart. 

Temporary lividity sometimes comes on in 
connection with diseases of the lungs, which 
shows that the blood is not sufficiently acted 
upon by the air entering the lungs. 

4* 



THE SKIN AND FEATURES. 



The skin, being very vascular and delicate, is 
liable to irritating, and unsightly diseases of 
various kinds. Many disorders of the skin are 
owing to an unhealthy state of the stomach and 
bowels, while others, like the eruptive diseases, 
are -owing to specific poisons in the blood. 

The cheeks of children are red and congested, 
in fevers and in inflammatory diseases. When 
this congestion of the face, ears and forehead, is 
circumscribed and changeable, it indicates disor- 
ders of the brain, or spinal cord, and so does 
cross-eyes coming on in connection with febrile 
derangements, with rolling of the eye-balls, pu- 
pils of the eyes of unequal size, drooping of 
the upper eye lids, &c. 

When there is severe inflammation of the lungs, 
there is often dilatation, or expansion of the nos- 
trils, with contraction of the eye brows, and 



THE SKIN" AND FEATUKES. 43 

flushed cheeks. Absence of tears during the act 
of crying, when the child is three or four months 
of age, is said to indicate a severe and probably 
fatal form of disease. When an infant loses 
flesh rapidly, cheeks become hollow, and bones 
prominent, there is doubtless derangement of 
the stomach and bowels, with diarrhea, so that 
the nutrition of the body is interfered with or 
arrested. 

Where there is great emaciation of features, 
which has been gradual in its progress, it surely 
indicates a chronic disease, of a severe charac- 
ter, as hydrocephalous, or dropsy of the brain, 
consumption of the lungs, or bowels, or chronic 
inflammation of the same. 

Where the eyes are continuously directed 
downwards, with expansion of the head, dropsy 
of the brain no doubt exists. 

All the eruptive diseases, and febrile disor- 
ders of children, are ushered in by changes in 
the appearances of the skin. 



CRYING, GESTURES, ATTITUDE. 



Where there is a sharp, shrill, piercing cry, 
head bent backward, limbs bent and stiff, spasm 
of the muscles, irregular movements of one or 
more limbs, with imperfect consciousness, there 
is almost certainly disease of the brain, or spinal 
cord, or both. Chorea, or St. Vitus dance, is 
characterized by irregular movements of the 
muscles, while in a state of perfect conscious- 
ness, and the muscular movements partly under 
control of the will. 

Turning the face from the light, contracting 
the eyebrows, a dislike of noise, shows that head- 
ache, sensitiveness of the eyes, or both, exists. 
When a child has severe ear-ache, it will every 
little while carry its hand to the ear, and press 
its ear against the breast of the mother, or nurse. 
In disease of the throat, children are restless, 
and move from side to side, while there is at the 



CRYING, GESTURES, ATTITUDE. 45 

same time, more or less trouble in swallowing, 
and difficulty in breathing. 

In pleurisy, the cry will be short and be sud- 
denly stopped, as the movements of the chest in 
breathing, cause sudden and sharp pain. When 
the child lies perfectly quiet, with sunken fea- 
tures, without smiling or crying, some severe 
and exhausting disease is present, like dysentery 
or chronic diarrhea. 



THE BREATHING. 



Breathixg, in the young infant is not regular 
as in older people, but, on the contrary, is very 
irregular, spasmodic, and the infant frequently 
sighs, has hiccoughs, often holds its breath while 
laughing, or moving suddenly about, or when its 
attention is fixed in any direction, or upon any 
object. The rapidity of breathing, or number 
of respirations per minute, is very variable at 
different periods of infancy, and in health and 
disease. Dr. J. L. Smith, from observations in 
the Children's Hospital of New York, has made 
a tabular statement of infantile breathing, as 
follows, the extremes of slowness and rapidity of 
breathing, being given. 

O " DO 

During the first week, 32 to 64 times per 
minute ; from the end of the first week to the 
end of the first month, 40 to 96 per minute ; 
from the close of the first month to the end of 
the third month, 32 to 68 per minute ; from the 



THE BREATHING. 47 

close of the third to the close of the sixth month, 
36 to 88 per minute ; from the close of the sixth 
month to the close of the first year, 28 to 64 
per minute. 

As the child advances beyond the age of one 
year, the frequency of breathing diminishes, but 
the breathing through the whole period of child- 
hood, is more rapid than in middle, or adult life. 

These figures represent the frequency of 
breathing in health, while in disease, it is ren- 
dered very irregular and variable. 

The character of the breathing in disease dif- 
fers very much, according to the nature and lo- 
cation of the disease. 

In diseases of the brain, or its membranes, the 
breathing is often slow, and intermittent, with 
sighing, particularly if there is more or less 
drowsiness. In diseases of the larynx and wind- 
pipe, with obstruction of the same, the breath- 
ing is much changed in character, the inspira- 
tion, or drawing in of the breath being much 
lengthened and difficult. 

The breathing is rapid in bronchitis, and 
especially so in capillary bronchitis, and when 
the drawing in of the breath stops short, the 
child at the same time uttering a moan, pleurisy, 
or lung fever, or both, probably exist. 



THE CHARACTER OF THE COUGH. 



The cough is an important symptom of dis- 
ease. In spasmodic croup, it is loud and sono- 
rous, and in true membraneous croup it is hoarse 
and harsh. In bronchitis it is clear and sharp ; 
low, suppressed, and painful, in lung fever and 
pleurisy, in whooping cough, it is convulsive, 
with inspirations, then expirations ; and in 
measles, the cough is dry, and irritating, es- 
pecially the cough that comes on prior to the 
appearance of the eruption. 

Derangements of the digestive organs, and the 
irritation of them produced by the presence of 
worms, often are attended with a cough of an 
irritating character. 

In all organic diseases of the lunsrs, the char- 
acter of the cough varies greatly with the pe- 
culiar kind of disease and its extent, and at dif- 
ferent stages of the same disease. 



THE CIRCULATION. 



The pulse is very variable in infants, and is 
much more rapid than in childhood, and in mid- 
dle and adult life. 

Any mental or physical excitement increases 
its frequency from twenty to thirty beats per 
minute. The average pulse of the healthy in- 
fant, is, according to Trousseau, 137 per minute, 
during the first and second months, 128 per 
minute from the third to the sixth month, and 
120 per minute from the sixth to the twelfth 
month. If the pulse of infants intermits, dis- 
ease of the brain, spinal cord, or their mem- 
branes, may be suspected. 

5 



THE DIGESTIVE SYSTEM. 



The examination of the mouth, will reveal the 
condition and diseases of the stomach and bowels, 
in children, and this is almost the only means of 
detecting these disorders in infancy. In health, 
the mouth is moist and pale, tongue smooth, 
gums red, and the breath free from offensive 
odors. These conditions, or appearances, become 
altered from slight causes, the mouth becoming 
hot and dry, the tongue coated with a white 
cheesy matter, the breath hot and sour. This 
is especially the case in fevers, and in inflamma- 
tion of the stomach and bowels. 

In severe cases of scarlet fever, measles and 
croup, the tongue often swells, and becomes 
coated, the color being of a dark brown. In 
scarlet fever, after the thick coating has disap- 
peared from the tongue, the follicles, or points 
of the mucous membrane, show through, and 



THE DIGESTIVE SYSTEM. 51 

give to the tongue a strawberry appearance, 
from its redness and roughness. The apthous 
sore mouth of infants, is often due to improper 
food, irritation of teething, impure air, using 
unclean nursing bottles, and to an unhealthy 
condition of the stomach and bowels. 

Vomiting is very frequent in infancy, and is 
common in brain affections, and it is also one of 
the first symptoms of scarlet fever and small- pox. 
Vomiting also attends indigestion, diarrhea, chol- 
era infantum and inflammation of the bowels. 

Flatulence, or the accumulation of gases in 
the stomach and bowels, is a source of great pain 
and uneasiness to infants, and this is particu- 
larly the case in scrofulous and weakly infants. 

Much is to be learned concerning the diseases 
of the stomach and bowels by the color, and 
character, of the discharges from them. Stools 
of bloody mucus, with fever, indicate inflamma- 
tion of the bowels. The discharges from the 
bowels are very often of a dark-greenish color, 
which color may arise from a variety of causes. 
It may be due to over feeding, to the action of 
cold, to irritating articles of food, and to inflam- 
mation. It may speedily disappear, and again, 
it may continue for several days. It often comes 
on in attacks of diarrhea and dysentery. It 



52 THE DIGESTIVE SYSTEM. 

sometimes manifests itself in children who are 
apparently in perfect health, and who seem to 
suffer no inconvenience from it, and it soon passes 
away without any treatment. 

The discharges from the bowels are frequently 
acid, having a sour smell, and so require alkalies 
to remedy the trouble. When the presence of 
worms are suspected in the bowels, the stools 
should be examined, when the truth of the mat- 
ter can be ascertained. Bloody discharges from 
the bowels may be owing to piles, polypus, or 
ulceration of the bowels. 

Sometimes the stools are white, clay colored, 
and of the consistence of putty, which is gener- 
ally owing to the absence of bile in the stools. 
All these changes in color, consistence and na- 
ture, have their peculiar and special significance, 
and call for special treatment, all of which will 
be found to be treated of under their appropri- 
ate heads, in the succeeding chapters. 



SLEEP. 



New-born infants sleep a greater portion of 
the time, occasionally awaking when they are 
eager to nurse, and soon as their appetite is ap- 
peased, fall asleep again. The sleep of the infant 
is quiet, sound, and long continued, in health, 
with breathing slow, and occasional sighing. In 
disease, the sleep is irregular, disturbed, breath- 
ing often loud and difficult, the eye brows are 
often contracted, mouth drawn one way or the 
other, there is grating of the teeth, sudden start- 
ings, and the infant may awake, cross, fretful, 
and not unfrequently will shriek out as if fright- 
ened. There is sometimes rigidity, or stiffness 
of the muscles, during sleep, with turning in of 
the fingers and toes, which indicates brain trouble 
and approaching convulsions. 

Care should be taken not to suddenly arouse 
infants from slumber, and as a general thing, 



54 SLEEP. 

the infant should be allowed to sleep until it 
awakens of its own accord. If the infant shows 
signs of convulsive disorders, it may be wise to 
terminate its sleep, in order to give it the neces- 
sary attention. 

Having treated of the peculiar symptoms of 
various diseases, and the methods of diagnosis, 
we will pass to the consideration of special 
diseases. 






JAUNDICE. 



Doubtless almost every one is familiar with 
the fact, that the color of the infant's skin is 
very changeable, during the first few days after 
birth. At first, being of a vivid reel, it gradu- 
ally changes into the light rose hue of the skin 
of a healthy baby. But the skin often takes on 
a different hue, of a deep yellowish tinge, usually 
showing itself on the third or fourth day after 
birth, growing more and more yellow for a few 
days, and gradually subsiding, or continuing for 
weeks and months, as the case may be, and 
especially is it apt to be prolonged if there be 
any organic disease. Sometimes the jaundiced 
hue is owing to changes taking place in the 
blood, in the over-congested skin, in which cases 
the color will soon disappear. In cases of this 
character, the white of the eye will not be yel- 
low, while in cases where there is functional or 



56 JAUNDICE. 

organic disease, the eyes will almost always be 
of a yellowish hue. Children in whom this 
jaundiced appearance is noticed are generally 
immature and feeble ; and offspring of unhealthy 
parents. 

In all these cases, the functions of the skin 
are inactive, breathing is but imperfectly per- 
formed, and the blood often circulates through 
channels which ought to have been closed at 
birth, and oftentimes, troublesome bleeding from 
the navel and other parts of the body, are liable 
to ensue. In many cases the whole difficulty 
will disappear if nothing is done, while in others, 
remedial measures are demanded. 

Great pains must be taken, while the yellow 
color of skin remains, to avoid all exposure of 
the infant to cold, and no other nourishment but 
the mother's milk should be allowed. Some- 
times a powder of chalk mixture, containing 
equal parts of chalk and magnesia, followed by 
a teaspoonful of castor oil, will hasten recovery, 
especially if the bowels have been, or are, inac- 
tive. When the yellow color of the skin is owing 
to inflammation of the bowels, or liver, or when 
owing to the want of bile ducts, or obstruction 
of them, when existing, the disease is very fatal. 
In these cases, bleeding oftentimes sets in from 



JAUNDICE. 57 

the navel, and other places, and no time should 
be lost in summoning medical aid, for it is diffi- 
cult, and sometimes impossible, to control it. 
In rare instances, a child will live on for several 
months, without any apparent improvement, the 
skin being of a dark yellow hue, body very much 
emaciated, the tongue and mouth, dry and red, 
and covered with white spots, and yet ultimately 
recover. 

The author has in mind, one case, where the 
infant continued to look exceedingly yellow for 
six months ; but afterward, taking the child from 
the breast, (the mother being consumptive,) and 
giving it-Liebig's food for infants, mutton broth, 
beef tea, &c, it grew better rapidly, and in a 
few months afterward, it was the perfect picture 
of health. 

In all cases of this kind, the bowels should not 
be allowed to go confined, but be kept regular 
and active, by the use of mild laxatives, like 
rhubarb, magnesia, &c. 

The greatest benefit is often derived from 
change of air, and location, by removal from the 
city to the country, or to the sea side, provided 
it be in the warm season. 



ERYSIPELAS. 



This is a disease that frequently affects infants 
soon after birth, and during childhood. In chil- 
dren thus affected, the skin will be found to be 
of a deep red color, hot, painful, and swollen. 
The places most usually affected, are the face 
and head, neck, about the navel, small of the 
back, and the buttocks. It usually begins by a 
small spot, which increases in size, and rapidly 
extends, and is attended with swelling and more 
or less chills and fever ; the child being restless 
on account of the burning and prickling sensa- 
tion of the skin. The ' infant sleeps but little, 
suddenly starts, and convulsions not unfrequently 
occur. When the disease affects the face, the 
lips swell, cheeks enlarge, the eyes are closed 
by the puffy lids, the features can hardly be rec- 
ognised, and the disease rapidly proves fatal, if 
it extends to the membranes of the brain. In 



EETSIPELAS. 69 

some cases the skin vesicates, or blisters, absces- 
ses form, and the parts slough. The treatment 
required in erysipelas, depends much upon the 
nature and severity of the case. It is generally 
the case that infants troubled with this disease 
are children of unhealthy parents ; ill-fed, living 
in dark, damp, unhealthy localities, so that one 
of the first things to be done in order to arrest 
the progress of the disease, is to admit fresh, 
pure air to the body of the patient, and have 
the room well ventilated. Many people are 
afraid to admit cool, fresh air into the sick room, 
for fear the disease will " strike in," but no fears 
need be apprehended on this score, and it is well 
for every one to remember, that nearly all of the 
infectious, and contagious diseases-, originate in, 
and are propagated by, filth and impure air. 

If the bowels are inactive, it is best to relieve 
them by the use of a little of the solution of the 
citrate of magnesia, teaspoonful doses of fluid 
extract of magnesia and rhubarb, or castor oil, 
if nothing else is handy. The patient's strength 
must be well supported, and when the mother's 
milk is deficient, a good wet nurse should be 
obtained, and cordials, wine whey, beef tea, 
mutton and chicken broth, and small doses of 
wine, either sherry or port, may be given to a 



60 ERYSIPELAS. 

child a year old, or more. The remedy most 
used and seemingly of the most benefit in 
erysipelas, is the tincture of the chloride of iron. 
To a child from one to two years old, it may be 
given in two or three drop closes every three 
hours, in sweetened water, and the dose may be 
increased to ten drops every four hours, for a 
child five or more years old. 

Local applications relieve the fever and burn- 
ing heat of the skin, and a solution made by 
steeping poppy heads in water, and applied by 
means of flannels wrung out of the solution, will 
be useful. Flour may be sprinkled on the in- 
flamed surfaces, and sugar of lead, twenty grains 
to a pint of water, may be used as a lotion. 
Tincture of iodine, and nitrate of silver, are 
sometimes applied to arrest the progress, or pre- 
vent the extension of the disease upon the skin, 
but these should only be used by physicians or 
those accustomed to their use. 

Pure air, sunlight, frequent bathing, general 
cleanliness, good and sufficient nourishment, are 
the best preventives of the disease. 



THRUSH. 



This disease is most apt to appear in those 
infants who are constitutionally feeble, or who 
are children of poor and unhealthy parents, sur- 
rounded by unhealthy, or unfavorable hygienic 
conditions. It is common among the poor of 
cities, and among foundlings in public institu- 
tions ; it also prevails among infants brought up 
on the bottle, and all who are ill-clad, ill-fed and 
ill-nourished. It depends upon derangement of 
the digestive organs, which afterwards produces 
inflammation of the mouth. 

On examining the mouth of an infant afflicted 
with this disease, you will observe that the 
mucous membrane is covered with small white 
spots, looking like curdled milk, but they will be 
found to adhere firmly to the lining of the mouth. 
These spots appear upon the inside of the lips, 
near the corners of the mouth, upon the inside 

6 



62 THRUSH. 

of the cheeks, and upon the tongue, being thick- 
est upon its tip and edges, and sometimes the 
disease affects the gums, causing a great deal of 
swelling and an abundant flow of saliva. When 
these spots first appear they are small, circular 
in shape, about the size of a pin head, and after- 
ward increase in size, sometimes running to- 
gether. When they disappear the mucous mem- 
brane or lining of the mouth, looks very red, 
and then gradually returns to its natural color. 

The disease oftentimes extends to the stomach 
and bowels, and occasionally proves fatal, if neg- 
lected, by preventing the nutrition of the body, 
so that death results from insufficient nourish- 
ment and exhaustion. In most cases, infants 
with this disease, grow thin in flesh, have colic 
pains, diarrhea, the discharge from the stomach 
at the same time, being sour and offensive, and 
the mouth being sore, the infant has but little 
disposition to nurse. 

The duration of the disease depends upon its 
intensity, and the favorable, or unfavorable, con- 
ditions of the child. If the child is otherwise 
healthy, and the disease slight, two or three days 
will suffice to effect a cure ; but if the contrary 
is true, it may take as many weeks to remove 
the difficulty. 



THKUSH. 63 

Soon as the spots show themselves, means 
should at once be employed to prevent the dis- 
ease extending. In mild cases, local applica- 
tions will often prove sufficient, while in the 
severer grades of the disease, both local and 
internal treatment will be required. 

One-half a drachm of borax, and one-half a 
drachm of chlorate of potash, dissolved in one 
ounce of glycerine, makes a very good local 
application, and it should be applied with a soft 
camel hair brush, taking care in the first place, 
to thoroughly rinse the mouth with warm water. 
It should be applied several times during the 
day, and if it does not soon remove the spots, 
the mouth may be washed with a weak solution 
of sulphate of zinc, after the following formula : 
Sulphate of zinc, two grains, to two ounces of 
rose water, or with a solution of nitrate of sil- 
ver, as follows : Nitrate of silver, two grains, to 
two ounces of rose water. Chlorate of potash, 
in two or three grain doses, may be given inter- 
nally, dissolved in water, three or four times a 
day ; or tea-spoonful doses of the following mix- 
ture : Chlorate of potash, one-half a drachm ; 
muriatic acid, ten drops; water, four ounces. 
There is often diarrhea, with green passages from 
the bowels, which needs attention. Some mild 



64 THKUSH. 

laxative, as rhubarb, and chalk mixture, or cal- 
cined magnesia, or solution of the citrate of 
magnesia may be given, and lime water and 
milk, if the stomach and the secretions are sour. 
In infants who are brought up by hand, the dis- 
ease is often found to be owing to the fact that 
the nursing bottles have not been kept clean 
and sweet, and therefore, strict attention should 
be paid to perfect cleanliness of the articles used 
in feeding the infant. They should be thor- 
oughly scalded, rinsed with pure cold water, 
and milk should not be allowed to stand in them 
for any length of time, when not in use. 

The person of the infant should be kept scru- 
pulously clean, and the clothes, especially the 
diapers, should be changed often. For diet, the 
infant should be confined to its mother's milk, 
or if the mother is not healthy, a wet nurse 
should be secured. 



FLATULENCE, OR WIND COLIC. 



It is very commonly the case, that infants are 
troubled with this affection for several days, or 
weeks, after birth. The bowels are distended, 
full, and hard, and the attacks of pain are fre- 
quent, and often severe, so that the infant is con- 
stantly restless and fretful. Infants of feeble 
constitutions, offspring of unhealthy parents, are 
the most liable to the affection, and though the 
mother furnishes abundant milk, and the child 
nurses well, yet it does not thrive. It may 
attack children of healthy parents, but in such 
cases it often appears that the mother does not 
furnish the infant sufficient nourishment, and 
the trouble is aggravated by feeding with im- 
proper food, which does not nourish the infant, 
but turns sour upon the stomach, and diarrhea 
and indigestion follow. If the stomach is sour, 
a few grains of bicarbonate of soda, magnesia, 

G* 



66 FLATULENCE, OR WIND COLIC. 

or a little chalk mixture, may be given. If the 
trouble is caused by the mother's milk, her diet 
should be so changed, and regulated, as to over- 
come the difficulty. 

When these simple measures fail, various 
remedies are resorted to, among the best of 
which are the following : A few drops of the 
tincture of assafcetida, and tincture of cinna- 
mon, in half a tea cup of warm milk and water, 
injected into the bowels once or twice a day, 
will afford prompt relief. 

The following mixture, taken internally, is 
very good. Carbonate or calcined magnesia, 
one scruple ; tincture of assafcetida, one drachm ; 
laudanum, ten drops ; water, one ounce. When 
the child is in pain, give twenty drops, in a lit- 
tle sweetened water, and if not relieved in an 
hour, give ten drops more. These doses are for 
an infant two or three weeks old, but if the 
child be much older a few drops more may be 
given, but it need not be repeated often, and 
must be stopped as soon as the pain is relieved. 

The aromatic remedies are much used, as an- 
nise, coriander, spearmint, cinnamon, catnep, 
etc. These are usually prepared in the form of 
a warm tea, and freely given. 

In some cases, the colic is periodical in kind, 



FLATULENCE, OR WIND COLIC. 67 

coming on every morning, or during the latter 
part of the afternoon, and children thus affected 
often look fat and healthy. Children with this 
periodical colic are often constipated, and if ha- 
bitually so, should be regulated in this respect, 
by the use of some mild laxative. In all these 
cases, the diet of both mother and child, should 
be carefully looked after. 



DISEASES ATTENDING TEETHING. 



Although teething is not a disease, but a 
natural process, it is nevertheless a time of great 
peril and fatality, to the infant, owing to the 
many derangements and diseases that set in 
during this period. It is the time when the 
infant is most rapidly developing, and is most 
likely to be affected by any, and every, source 
of irritation and disturbance of the system. 
Some of the most common disorders have been 
alluded to in the chapter upon teething, while 
some of the more special diseases attending 
teething, will be treated of here. 



MILKY SCALL. 



This is an eruptive disease of the skin, most 
always confined to infants teething. The disease 
appears sometimes earlier, sometimes later, in 
the period of teething. It often begins on the 
cheek or forehead, and is recognized first by a 
small collection of white pustules upon a red 
surface, the pustules gradually fading to a brown, 
or yellowish brown color, which finally breaks, 
forming a crust of variable thickness, from 
beneath which, there proceeds a thick, dirty, 
discharge. New eruptions constantly appear, 
which unite with the old, and so extend over the 
face, head, and various parts of the body, and 
sometimes the whole face and scalp will be 
entirely covered. 

This disease is troublesome and offensive, but 
not often dangerous, or serious in its results, 
although death has been known to take place, 



70 MILKY SCALL. 

owing to the constant itching, fever and diarrhea, 
attending the severer cases. It is the popular 
opinion in domestic circles, that it is dangerous to 
cure these affections of the skin, on account of 
giving rise to some internal trouble, but such fears 
need not be entertained. Although the eruption 
will disappear in time if left to itself, on account 
of the loathsome appearance, and uncomfortable 
feeling, treatment is called for to hasten its 
removal. The bowels should be acted upon by 
mild doses of magnesia, confection of senna, oil, 
or any other laxative that is suitable, and if the 
child be at the breast, the mother should gener- 
ally resort to a milk and vegetable diet, using 
but little animal food. If the child be weaned, 
then arrowroot, wine whey, milk, &c, should be 
given. The warm bath should be had recourse 
to every, or every other day, and the face, head, 
and other parts affected, should be washed often 
with castile soap and water, after which, the 
ointment of benzoated oxide of zinc, should be 
applied twice daily, morning and night. 

These simple measures will be found all suffi- 
cient in most cases, but there may be cases where 
some tonic will be needed, in order to build up, 
and strengthen the system, and remedies to 
improve the condition of the blood. 



TOOTH RASHES. 



The sympathy between the gums and skin, is 
abundantly shown by the number and variety 
of eruptions which the skin is liable to, during 
the teething process. The tooth rash, is an 
eruption of numerous small papillae, or pustules, 
appearing on different parts of the body, and is 
so called because it appears at no other period 
excepting that of teething. 

At about the fourth or fifth month, this erup- 
tion appears on most infants, and is noticed most 
frequently on the cheeks, side of the nose, fore- 
head and arms, and sometimes extends over the 
whole body. The disease usually lasts but a 
few weeks, and requires but little treatment, 
beyond regulation of the bowels, if constipated, 
keeping the skin clean, by frequent washing 
with warm water, and using nothing but linen 
next to the skin. The pimples will soon fade out, 
cast off their scales, and finally disappear. 



RED GUM. 



This is an eruptive disease, that affects the 
great majority of children during the first month 
of their existence. Many nurses look for its 
appearance with pleasure, and if it fails to put 
in an appearance will dose the infant with saffron, 
catmint, sage, &c, after which they will often be 
rewarded with a generous eruption. 

The eruption is generally owing to disorders 
of digestion, caused by an acid condition of the 
stomach, taking too much milk, or by some im- 
proper quality of the mother's milk. The com- 
plaint is often preceded by nausea and vomiting, 
or diarrhea. It is sometimes caused by the 
infant being too warmly clad, its head being 
covered with clothing, so that it is compelled 
to breathe over and over again, the same air, 
causing profuse perspiration. 

The eruption is most commonly situated on 



KED GUM. 73 

the face, arms, hands, chest, and occasionally on 
the whole surface of the body. In all ordinary 
cases, the disease requires no medical treatment. 
It is well to pay proper attention to cleanliness, 
diet, and digestion, and the infant should not be 
exposed to changes of temperature, from hot to 
cold, for it may cause the eruption to suddenly 
disappear, and result in difficulty of breathing, 
drowsiness and spasms. In such cases the in- 
fant turns pale and purple around the mouth, 
refuses to nurse, stretches itself out stiff, and 
suddenly becomes relaxed, with cold skin. The 
warm bath should be immediately resorted to, 
until the child's body is warm, when it should 
be rubbed dry, and clothed in warm flannel, and 
have some warm tea, or stimulating drink ad- 
ministered, as saffron, sage, sweet marjoram, etc. 
7 



WHITE GUM. 



This eruption is characterized by small, hard, 
white, specks, but little elevated from the sur- 
face of the skin, somewhat resembling warts in 
shape and structure. They are most frequently 
observed on the face, neck and chest, and they 
last for some time. No treatment is necessary, 
beyond the regulation of diet, attention to clean- 
liness, and the general health. 



SORE EARS. 



Children, during the teething process, fre- 
quently have sores form behind the ears, which 
soon spread and take on an ulcerative character, 
often involving the whole ear. A large quan- 
tity of pus, or matter, issues from the ulcerated 
surface, forming thick, dirty, scabs, or crusts. 
In treating this affection, the diet must be well 
regulated, no improper or indigestible food being 
given ; the bowels must be acted upon by some 
gentle laxative ; the sores must be thoroughly 
cleansed with soap and water, or what is better 
with a weak solution of carbolic acid and water. 
After thoroughly cleansing the ulcerated sur-' 
faces, an ointment of the benzoated oxide of zinc, 
should be applied night and morning. If the 
child is pale, bloodless and feeble, a few drops 
of the ferrated wine cordial may be given three 
or four times a day, or small doses of wine whey, 



76 SORE EARS. 

blackberry, or native grape wine. The disease 
will usually yield promptly to the remedies 
mentioned ; but in some cases of long duration, 
some general, or constitutional treatment may 
be required. 



OTTORRHEA, OR INFLAMMATION OF THE 
EARS. 



Attacks of ear ache, or inflammation of the 
internal ear, are the most common after the com- 
pletion of the first teething, yet they occur in 
young infants, who are wholly unable to point 
out the seat of pain. Sometimes the attacks 
suddenly manifest themselves, but more fre- 
quently, the child is nervous, fretful, uneasy, or 
languid, ranging from several hours, to several 
days, before the severe pain follows. The child 
will cry, if tossed about, noise seems unpleasant, 
it notices nothing with interest, and if at the 
breast manifests no desire to nurse. The infant 
keeps moving its head about, striving to place it 
in a comfortable position, and on watching closely, 
it will be seen that it is always the same side of 
the head, (when one ear alone is affected,) that 
it buries in the pillow, or rests on its mother's 
arm, and no other position seems to afford much 

7* 



78 OTTOEEHEA. 

relief. The pain is often followed, after a time, 
by a profuse discharge of matter from the ear, 
which affords great relief, and the trouble appar- 
ently disappears for a time. Other cases assume 
a chronic form, with a continued discharge, which 
is very offensive, and which goes on to the injury 
or destruction, of the internal ear, resulting in 
deafness, or inflammation of the membranes of 
the brain and death. 

In treating this painful affection of children, 
warm applications should be made to the ear, 
such as poultices of bran, hops, chamomile flower, 
or roasted onions, or a little sweet oil, to which 
a few drops of laudanum has" been added, may 
be put in the ear occasionally. If the discharge 
from the ear is profuse and persistent, the sur- 
face of the canal should first be cleansed by in- 
jecting in a little warm water, after which, the 
canal of the ear, should be painted, or brushed 
over with a solution of nitrate of silver, of the 
strength of from six to ten, and even twenty 
grains, to the ounce of water ; but this applica- 
tion should be entrusted alone to the physician. 
If the ear ache and discharge continues, it 
becomes necessary sometimes, to apply a blister, 
or leeches, behind the ear. Proper attention 
should be paid to the general health of the infant, 



OTTOEEHEA. 79 

for it is true, that most children troubled with 
this affection, are children of feeble, scrofulous 
constitutions, and require tonics, such as syrup 
of the iodide of iron, wine of iron and calisaya 
bark ; they also want good nutritious diet, pure 
air, out of door exercise in favorable weather, 
and sunlight. 

It is highly important that these inflammatory 
diseases of the internal ear, should not be neg- 
lected, for they not only often leave behind per- 
manent disorganization of the ear, and conse- 
quent deafness, but the disease is always liable 
to extend, and involve the membranes of the 
brain, producing inflammation thereof, and sub- 
sequent death, and the verdict should be rendered 
in all such cases, death from neglect. 



INCONTINENCE, OR INABILITY TO 
RETAIN THE URINE. 



This trouble is exceedingly common in early 
life, and although it is frequently caused by force 
of habit rather than by any special derange- 
ment, it often proves a serious infirmity, and one 
not easily overcome. It usually affects children 
more during the night, than the daytime, though 
both forms of the disease are met with in chil- 
dren. The causes of this difficulty are various, 
the principal ones being as follows : In the first 
place, it is often caused by bad habits, as letting 
the child drink freely during the evening, and 
on going to bed, and that too without seeing that 
the child empties its bladder before retiring. 
Lying on the back at night, is a position that 
favors the involuntary flow of urine, and should 
be avoided. Again it may be, and often is, 
owing to the urine becoming a source of irrita- 
tion, by an excess of lithic acid in the secretion. 
Sometimes it is caused by the irritation produced 



INCOXTIXENCE 81 

by the presence of the small round, or pin worm, 
in the lower bowel or rectum. It is not an un- 
common thing for infants to suffer from gravel, 
or stone in the bladder, in which case there will 
be more or less incontinence of urine. 

In seeking to remedy this difficulty, a little 
genuine authority will prove beneficial, provided 
it is rightly exercised, such as making the child 
abstain from drinks of all kinds, two or three 
hours before going to bed, and if possible making 
the child empty its bladder before retiring, and 
two or three times during the night, and taking 
care that the child lies on one side or the other, 
and not on its back. 

The remedial measures, so far as medicine is 
concerned, will depend upon its cause. If there 
is an abundant deposit in the urine, or if the 
urine is very acid, attention must be directed to 
the diet, which must be simple, nutritious, and 
regular. Magnesia, bicarbonate of soda, acetate 
of potash, either one of them may be given to 
neutralize the acidity of the urine. If worms 
infest the rectum, an injection occasionally given, 
consisting of a strong solution of salt and water, 
will kill them. If they infest the other portion 
of the intestines, fluid extract of pink root and 
senna may be given, three times a day, on an 



82 INCONTINENCE. 

empty stomach, followed the next day by some 
cathartic. Santonine is also a valuable vermi- 
fuge, and may be given in two or three grain 
doses, three times a day. 

Tonic remedies are demanded in children of 
feeble constitutions, and in this peculiar affection, 
the tincture of the chloride of iron is good, and 
may be given in doses of five to ten drops, three 
times a day, in a wine glass of sweetened water. 
Cold sponging to the back and thighs, is useful, 
and in the long continued cases, blisters applied 
to the small of the back and thighs, afford relief, 
though they are not desirable things to use on 
children. Nux vomica and belladonna, are two 
valuable remedies in this 'disease, and in fact, the 
great majority of cases will yield either to one 
or the other of these two, or the tincture of iron 
spoken of above. The tincture of nux vomica 
and belladonna, may be given in four or five 
drop doses, repeated three or four times daily, 
to young children, the dose being increased for 
those above four or five years of age. The 
presence of stone or calculi, in the bladder, or 
the presence of tumors about the neck of the 
bladder, or its appendages, will only be detected 
by the physician, and of course will call for his 
interference. 



DIABETES. 



An abundant flow of urine occurs at all ages, 
as a primary and temporary symptom of various 
diseases, but in diabetes, the increased flow of 
urine is associated with certain changes in the 
chemical composition of the urine itself, the 
presence of sugar sometimes being detected in 
considerable quantity. The disease is attended 
with great thirst, there being a constant desire 
to drink in large quantities, and the appetite is 
often ravenous, yet the child will become very 
much emaciated, pale and feeble. The disease 
is not common in very young children, yet they 
are not exempt. 

The primary cause of diabetes, is derangement 
of the processes of assimilation, and nutrition, 
the processes by which food imparts its virtues 
to maintain the health, vigor and growth of the 
body. There seems to be no effectual remedy 



84 DIABETES. 

for the disease, but much can be done to modify 
it, and relieve the patient. Alkaline medicines 
have, been useful, among which are bicarbonate 
of soda, a few grains to be given three or four 
times daily, in water, occasionally omitting it for 
a few days. The carbonate of ammonia, or 
citrate of ammonia, have been found very bene- 
ficial in this disease, and they can be given three 
or four times daily, in five grain doses, dissolved 
in water or syrup. Food containing much sugar 
or starch should be avoided, but meat of all 
kinds may be allowed, with " butter, cream, 
curd, cheese, eggs, and all vegetables deficient 
in starch and sugar, such as lettuce, cabbage, 
chicory, tops of beets, spinach, celery and water 
cresses." Vegetables which abound in starch 
and sugar, such as rice, potatoes, beets, turnips 
and beans, are not to be allowed ; neither is 
wheat or rye bread, corn or oat meal. Tea and 
coffee, claret and sherry wine, are useful. 

The skin should be thoroughly protected from 
cold, and frequent bathing in warm water should 
be practiced. 

Children suffering from this affection should 
not be sent to school, but should be allowed 
complete freedom from mental taxation, and 
should exercise in the open air freely. 



CONSTIPATION. 



By constipation is meant an inactive state of 
the bowels, in which there may be no passages 
from the bowels for two days or two weeks. 
Constipation may be considered a symptom of 
various diseases and derangements, rather than 
a disease itself, although it may become one. 
This may be a constitutional trouble, or may be 
acquired by habit, or by improper diet, and use 
of drugs. Dosing children continually with 
laudanum, soothing syrup, paregoric, &c, is a 
fruitful source of the complaint. The disease is 
sometimes owing to malformation of the bowel, 
in which the size of the bowel is diminished, or 
completely obstructed, a trouble that children 
are often born with. Constipation is often owing 
to simple torpidity of the bowels, in which case, 
the difficulty can be removed by gentle laxative 
remedies, such as manna,rhubarb, magnesia, the 



8G CONSTIPATION". 

confections of senna, &c. Pepsine is useful in 
many cases, given in doses of from three to six 
grains dissolved in milk, the dose to be repeated 
three or four times daily. Injections of simple 
cold water, molasses and water, or salt and water, 
into the bowel, is an effectual remedy, affording 
prompt relief. At least, from a gill to a pint 
of liquid should be injected at once, in order to 
insure success. Small closes of tincture of bella- 
donna, with aloes, or colocynth, is a prompt 
remedy, but is best adapted to children above 
five years, or older. As the disorder is acquired 
by the force of habit, the habit being that of 
protracted neglect of the necessity, whenever it 
arises, so can a cure be accomplished by the force 
of habit, if the individual will make daily, and 
regular effort to secure action of the bowels, 
whether the necessity seems to exist or not. In 
order to keep the system in good condition, one 
movement of the bowels should be secured every 
day. 



VOMITING. 



This is one of the most common affections of 
infancy and childhood, and also a prominent 
symptom of various diseases, such as pneumonia, 
scarlet fever, measles, chicken and small-pox, 
brain fever, and the various disorders of the 
stomach and bowels. 

Infants frequently vomit from mere repletion, 
the stomach having been overloaded by too fre- 
quent nursing. In these cases the vomiting will 
sometimes be frequent and violent, yet the infant 
does not seem to suffer much from it, as there 
seems to be almost no debility, or constitutional 
disturbance produced by it, and it is nothing but 
the simple effort of nature to relieve the overfed 
organ. The infant may have a good appetite 
and nurse freely, but the stomach being in an 
irritable condition, it immediately rejects the 
milk, either in its natural state or curdled. This 



88 VOMITING. 

state of things is often produced by some act of 
impropriety of the mother, or nurse, such as 
allowing a too long interval before nursing the 
child ; giving the child the breast immediately 
after a fatiguing walk or other exercise ; or 
arousing the infant suddenly from sleep, before 
the usual time. It may be due to over excite- 
ment, fatigue, and exposure of the infant. 

In treating a child in whom vomiting has 
come on in this way, take it at once from the 
breast, and allow it nothing for two or three 
hours, then give it simply a teaspoonfiil or two 
of cold water, and if that is retained in the 
stomach, repeat it in half an hour. Should the 
last be retained, then dissolve a little isinglass 
in water, and give it in two teaspoonful doses, 
oft repeated. Cold barley water, rice water, 
flax seed tea, may be given in like manner. 
After a few hours have elapsed, the mother's 
milk, or diluted cow's milk, may be allowed in 
small quantities. If milk disagrees with the 
child, weak lamb or chicken broth may be sub- 
stituted. After twenty-four, or forty-eight 
hours, if the vomiting ceases, the infant may be 
allowed the breast regularly, care being taken 
not to nurse the infant too long, and too often. 

Although the trouble is usually overcome by 



VOMITING. oy 

proper attention to diet, it sometimes calls for 
medical treatment. Where the milk is thrown 
off curdled, showing the existence of acidity of 
the stomach, lime water, in teaspoonful doses, 
should be given three or four times daily. Ox- 
alate of cerium, in one or two grain doses, given 
in a teaspoonful of cold water, and repeated 
every three or four hours, will often prove very 
effectual. If there be vomiting, with much 
diarrhea, a grain of the mild chloride of mercury 
may be placed upon the child's tongue, at the 
same time forbidding the infant to nurse. In 
two hours the following mixture, recommended 
by Dr. J. Lewis Smith of New York, may be 
given : bicarbonate of potash, twenty-four grains ; 
citric acid, seventeen grains ; bitter almond 
water, one ounce ; water, two ounces ; mix and 
give the child a teaspoonful occasionally, until 
vomiting ceases. The following mixture has also 
been found useful in the Childs' Hospital, of 
New York : creasote, two drops ; lime water, 
two ounces ; mix and give one teaspoonful with 
a teaspoonful of milk. 

Vomiting is not always a solitary symptom, 
nor a disease by itself, but is frequently associa- 
ted with general disturbances, impairment of 
the digestive organs, by which nutrition is 



90 VOMITING. 

arrested, the child wastes away, and pulmonary 
consumption is the final result. Often in these 
cases, the infant has no appetite at all, either for 
the breast or anything else, grows pale, languid, 
nurses occasionally, often vomiting as it ceases 
to nurse. This trouble may also be caused by 
too close confinement of the infant, in hot, 
ill-ventilated rooms, and it often follows attacks 
of diarrhea and inflammation of the bowels. 
There may be a craving and unnatural appetite, 
and soon as the child takes any nourishment, it 
will cry with pain until relieved by vomiting. 
In other cases, the infant has frequent belching 
of wind, of a sour, nauseous odor, with attendant 
diarrhea, or constipation, as the case may be. 
If the infant is fed upon the breast entirely, the 
stools will generally be liquid, of a pale yellow 
color, often curdled, while at other times they 
will look like putty, or pipe clay, of a greyish 
white appearance, and at other times they will 
present a dirty, slimy, green color, frequently 
tinged with blood, and very offensive. 

In all cases of vomiting, diarrhea, or general 
disturbance of the digestive organs, hygienic 
and sanitary measures are the first to be looked 
after, and enforced. 

The nursery, or where the child remains most 



VOMITING. 91 

of the time, should be kept well ventilated, and 
at a moderate temperature, and not hot as an 
oven, as is too often the case. The room should 
be on the sunny side of the house, well exposed 
to the sun's rays, for there is health imparting 
power in sunlight, not generally attributed to 
it. Change of air from one location to another, 
will often effect a cure, especially if it be to some 
elevated and thinly populated place. Care must 
be taken not to overload the stomach, for too 
little is better than too much for a weak stomach. 
Tonic remedies are often required to build up 
and strengthen the feeble vital powers. The 
following is recommended by Dr. J. Lewis Smith 
of New York: Dilute sulphuric acid, sixteen 
minims ; tincture of orange peel, one drachm ; 
cinnamon water two drachms ; simple syrup, 
one drachm ; the whole to be mixed and given 
in teaspoonful doses three times a day to an 
infant a year old. Citrated kali, bismuth, calcined 
magnesia, oxalate of cerium, are all useful. 

If the bowels are inactive, castor oil, decoction 
of aloes, and glycerine, confection of senna, will 
any of them relieve. 

A formula recommended is as follows : Com- 
pound decoction of aloes, six drachms ; extract 
of liquorice root, one scruple ; ansise water, two 



92 VOMITING. 

drachms ; mix and give it in one or two tea- 
spoonful doses, when needed. 

Where the trouble with the stomach has been 
long continued, digestion being but imperfectly 
performed, attention to diet, combined with 
various medicinal remedies, will usually establish 
a cure. If the child has been brought up on 
cow's milk, benefit is often derived by diluting 
the milk, or by changing it for asses' milk, or 
goat's milk, or Avhey. Small quantities of car- 
bonate of soda, or potash, chalk, magnesia, or 
lime water, should be added to the milk, and if 
the stomach be very irritable, small closes of 
laudanum may be added. Sometimes it is well 
to combine the alkali, as soda, potash, &c, with 
a vegetable tonic, as an infusion of columba, 
gentian, and quassia. 

In cases where the breath is offensive, with 
frequent belching of the gases of the stomach, 
the following formula may be used: Dilute 
hydrochloric acid, twenty drops ; syrup of orange 
peel, one drachm ; tincture of orange peel, one 
drachm ; infusion of cascarilla, ten drachms ; 
mix and give a teaspoonful three times daily. 
The wine of pepsine, given in ten or fifteen drop 
doses, three or four times daily, is useful. The 
diarrhea associated with these cases, so often 



VOMITING. 93 

seen with pale yellow, or dark green stools, is 
relieved by moderate diet, and small doses of 
sulphate of magnesia, and tincture of rhubarb, 
say five grains of magnesia, and twenty drops of 
rhubarb, given three or four times a day, to a 
child a year old. When the passages from the 
bowels are white, or clay colored, the mercury 
and chalk powder, may be given morning and 
night, in small doses, or if the vomiting contin- 
ues, small doses of the mild chloride of mercury 
combined with a grain of Dover's powder, will 
afford the most prompt relief. While vomiting 
is a symptom of, and attends so many disorders, 
such as inflammation of the brain, bowels and 
stomach, scarlet fever, measles, cholera infantum, 
&c, it is highly important that the cause should 
be sought out, that the proper remedies may be 
applied. The causes, especially where they 
originate in the brain, are often obscure, and all 
the skill and foresight of the best medical men is 
requisite in such cases, and they should be 
entrusted to them alone. 



DIARRHEA. 



This, like vomiting, is one of the most fre- 
quent of infantile disorders, and during the first 
two years of life, it is constantly manifesting 
itself in some one of the various forms, and 
from a great variety of causes. 

The following are among the more common 
causes of simple diarrhea. Improper diet, the 
milk, or food, being given in too great quantities, 
or of a poor, unhealthy quality; feeding too 
frequently, so as to overtax the digestive organs, 
arresting the process of digestion, so that the 
food acts as an irritant, and excites frequent 
discharges. At other times, some property of 
the mother's or cow's milk, disagrees with the 
infant, producing the diarrhea. Fright, or any- 
thing unduly exciting the nervous system of the 
mother or child, is a sufficient cause. Sudden 
changes of temperature, exposure to cold, or to 



DIARKHEA. 95 

excessive warmth will induce it. The eruption 
of the teeth, and the irritation produced by their 
pressure upon the gums, is a common cause. 
Worms in the rectum, or lower part of the bowel, 
not unfrequently excite diarrhea, and children 
who are kept in dark, damp, close apartments, 
without ventilation, are almost always subjects 
of this disease. 

The simple form of diarrhea, which is not 
attended by inflammation or much pain, usually 
comes on without much warning. In diarrhea 
caused by fright, exposure to cold, or improper 
diet, the attack usually comes on directly after 
the exposure. If caused by teething, symptoms 
which are referred to the mouth, will be noticed. 
The symptoms generally preceding an attack 
of diarrhea, are more or less heat of skin, rest- 
lessness, disturbed sleep, an expression of pain, 
with more or less nausea, and vomiting, if the 
attack is to be at all severe. 

The most frequent color of the stools in young 
infants afflicted with diarrhea, is a dirty, slimy, 
greenish color. This arises from the most 
trivial causes, and need excite no alarm, if 
properly attended to. When the infant is suffer- 
ing from indigestion, the stool will often present 
the appearance of curdled milk, and in fact, they 



96 DIARRHEA. 

often consist of but little else. The face of the 
infant is pale, and the flesh flabby, but there is 
no great loss of flesh, or prostration, unless the 
diarrhea has continued for some length of time. 
There is but comparatively little danger in the 
common diarrhea of children, unless the disease 
is allowed to continue so as to undermine the 
general health, and constitution, and till it be- 
comes complicated with some organic disease of 
the bowels or brain. 

In order to relieve the diarrhea, the cause of 
the difficulty must, in all cases, be sought for, 
and removed if possible, when the trouble will 
in most cases soon end. 

In those cases where the passages from the 
bowels are acid, and frequent, it is well to give 
some alkali, with a laxative, such as teaspoonful 
doses of the fluid extract of rhubarb and mag- 
nesia, or a little of the Rochelle salts, given with 
the syrup of rhubarb, or a teaspoonful of castor 
oil, with five grains of the bicarbonate of soda, 
given in a little sweetened water, or five grains 
of bismuth, with a teaspoonful of the citrated 
kali, given in a little water. The following is a 
useful mixture where there are loose, watery 
discharges, without much pain or straining : Sul- 
phate of magnesia, three drachms ; tincture of 



DIARKHEA. 97 

rhubarb, two drachms ; tincture krameria, two 
drachms ; syrup of ginger, half an ounce ; com- 
pound tincture of cardamons, half an ounce ; 
mix and give one teaspoonful three or four times 
daily, to an infant one year old, increasing the 
dose according to the age. 

In cases where there is a sour stomach, with 
acid discharges from the bowels, the following 
remedy may be used : Pulverized ipecac, one 
grain ; pulverized rhubarb, two grains ; bicar- 
bonate of soda, and subnitrate of bismuth, each 
five grains ; mix and make twelve powders, one 
to be given every four hours. If the diarrhea 
should continue three or four days, astringent 
remedies will be called for. The following is a 
good formula, recommended by Dr. West : Ex- 
tract of logwood, one drachm ; tincture of cat- 
echu, two drachms ; simple syrup, one drachm ; 
caraway water, nine drachms ; mix and give one 
teaspoonful three times a clay. 

In diarrhea, attended with great straining, or 
spasmodic action of the lower bowel, with fre- 
quent painful discharges, injections into the bowel 
of the following mixture, will afford prompt relief: 
Prepare a teacupful of starch water as thick as 
can be used in a syringe, the starch to be boiled, 
to which add ten or twelve drops of laudanum, 

9 



98 DIARRHEA. 

and give the injection two or three times a day 
till relief follows. 

In the severer cases, attended with discharges 
of blood and matter from the bowel, two or 
three grains of nitrate of silver should be added 
to each injection. The compound powder of 
chalk and opium is a very good preparation for 
infantile diarrhea, and may be given in doses of 
from one to three grains, to a child one year 
of age. When there is great irritability of the 
stomach, so that everything is thrown up soon 
as taken, Dr. West advises a small mustard 
poultice applied to the stomach, the child to be 
taken from the breast if nursing, and fed on cold 
barley water, or something as simple in its nature, 
and then a powder containing a third of a grain 
of the mild chloride of mercury, and a twelfth 
of a grain of opium, to be placed upon the 
tongue every three hours. Where the nervous 
system is irritable, and there is evidence of any 
tendency to disturbance of the brain, and con- 
vulsions, the warm bath should be resorted to, 
and cold applications be made to the head, as 
cloths wrung out in ice water, and frequently 
changed. 

In cases attended with great debility, feeble 
pulse, coldness of the skin, &c, stimulants, such 



DIAKKHEA. 99 

as blackberry wine, small doses of brandy, will 
be required, and rubbing the body thoroughly 
with strong mustard water, and placing hot 
drafts to the feet, or bottles of warm water, will 
be very useful, and afford much relief by the 
reaction they excite. 

In cases where the disease has involved the 
brain, the child will be exceedingly restless, will 
sleep but a few moments, and suddenly awake, 
and cry out with a shrill piercing cry, and throw 
its arms about and above its head, oftentimes its 
hands will be closed and stiff, face pale, eyes 
presenting a glassy appearance, and rolling 
around uneasily. Serious, and too often fatal, 
consequences follow these symptoms, and the 
very best possible attention from the nurse and 
medical attendant, is required, for relief must be 
obtained soon, if at all. The warm bath should 
be employed, and small doses of Dover's powder 
should be given, with free use of stimulants, 
particularly if there is great paleness and cold- 
ness of the skin. 



CHOLERA INFANTUM. 



Cholera infantum, is so called, on account of 
its close resemblance to Asiatic cholera, in its 
general symptoms. It is a disease occurring only 
in warm weather, and the causes are various, as 
follows : Improper diet, too thin clothing, teeth- 
ing, worms, premature weaning, or weaning 
during the hot months, living in ill-ventilated 
apartments, the air being loaded with foul, nox- 
ious vapors, such as arise from animal and 
vegetable decomposition, or from over crowded 
rooms, and also from want of general and per- 
sonal cleanliness. For these reasons, the cases 
are most frequent among the poorer classes, who 
dwell in large tenement houses, and in low, damp, 
unhealthy localities. There are but a few cases, 
comparatively speaking, in well appointed houses, 
where diet, dress, exercise and cleanliness receive 
their due attention. The intense heat of summer, 



CHOLERA INFANTUM. 101 

is, no doubt, the primary cause in most cases, 
and infants fed on the bottle, are much more 
liable to it than children at the breast. The 
disease usually attacks children who are under 
two years of age. 

Cholera infantum sometimes comes on as a 
simple diarrhea, with some disturbance of the 
stomach, at the same time the trouble increases, 
until the disease assumes a violent form. In 
the most severe forms of the disease, there are 
vomiting and purgings, with violent cramps of 
the limbs, and at times of the whole body. The 
passages increase in frequency from the bowels, 
are thin and watery, and the child sinks rapidly. 
Sometimes a diarrhea for several days precedes 
an attack, while at other times, it will appear 
almost without warning of any kind. Whatever 
is swallowed, is at once rejected, on account of 
the great irritability of the stomach, and there is 
a total loss of appetite, with great thirst. The 
loss of flesh and strength is exceedingly rapid, 
and the whole appearance of the child is so much 
changed, often in a single day, that it looks like 
another person, or not at all like itself. The 
eyes are sunken, lips and eyelids often perma- 
nently open, because the muscles are so much 
relaxed, and the skin will be found in folds, or 



102 CHOLERA INFANTUM. 

puckered up, on account of the great loss of the 
fluids of the body. The disease often proves 
fatal in twenty-four, or forty-eight hours, and in 
the severer attacks, the infant will often lie in a 
state of stupor, and can with difficulty be aroused, 
the head and limbs become cool, eyes bleared, 
and glassy, pupils contracted, the eye balls roll 
about during the paroxysms of pain, and there 
is often profuse perspiration. 

When the child passes into a state of stupor, 
death is apt to follow in a few hours. The dis- 
charges from the bowels are so frequent, thin 
and watery, and the sinking of the infant is so 
rapid, that the most prompt and decisive meas- 
ures are demanded in the treatment of this 
disease. 

If the child has taken any unusual article of 
food, or anything in the shape of fruit, or vege- 
tables, which is often the case, and this acts as 
an irritant to the stomach, and bowels, something 
should be given that will act as a laxative, or 
purgative, in order to expel the offending mate- 
rial from the bowels. Small doses of ipecac, 
three or four grains of the powder, may be given 
in a little water, to clear the stomach, provided 
the efforts of nature have not been sufficient. 
To clear the bowels, small doses of castor oil, 



CHOLERA INFANTUM. 103 

rhubarb, magnesia, may be given, but the best 
of all remedies is calomel, given in one grain 
doses, combined with a grain of the camphorated 
Dover's powder, both to be rubbed together with 
a little sugar of milk, and placed upon the tongue. 
If the first dose is rejected, immediately repeat 
the dose, and so on till the powder is retained. 
This settles the stomach better than most any- 
thing else, and whatever objections older people 
may have to its use,, it certainly is harmless to 
children, properly administered, and no question 
should be raised against its use in a disease which 
might prove fatal in a few hours without it. 
But where any one has any objection to its use, 
syrup of rhubarb, or fluid extract of rhubarb 
and magnesia, may be given, provided the 
stomach can be made to retain it long enough 
to have the desired effect. If the calomel is 
used, it should be in one grain doses, and not be 
repeated more than three or four times, before 
some other laxative is given. 

Purgative medicines need not be given at all, 
unless there is evidence that there is some irri- 
tating and indigestible substance in the bowels, 
that needs to be removed. Treatment should 
then be given to improve the general character 
of the discharges, and to lessen their frequency, 



104 CHOLERA INFANTUM. 

without delay. Our main reliance is upon opium, 
in some of its various forms. Laudanum may 
be given in one drop doses, to a child one year 
old, and repeated every half hour or hour, its 
effects being watched, so that the child may 
'receive no unfavorable effect therefrom. Some- 
times sudden stupor comes on, the discharges 
from the bowels suddenly cease, in which condi- 
tion opium would increase the difficulty, and 
hasten the fatal result. 

Other preparations of o'pium, besides lauda- 
num, often used in this disease, are paregoric, 
compound powder of chalk and opium, and Do- 
ver's powder. To check the discharges, an 
alkali and an astringent may be used together, 
such as the following : laudanum, twelve drops ; 
chalk mixture, one ounce and a half ; tincture 
of catechu, two drachms. Mix, and give tea- 
spoonful doses, every two hours, to an infant a 
year old. Another useful mixture is as follows : 
laudanum, twelve drops ; tincture of krameria, 
three drachms ; bismuth, one half a drachm ; 
cinnamon water, an ounce and a half. Mix, and 
give in teaspoonful doses, every two or three 
hours. Some eminent authorities, as Billet and 
Barthez, prefer nitrate of silver, dissolved in 
distilled water, as an astringent, in cholera in- 



CHOLERA INFANTUM. 105 

fantum. It is certainly effectual, given with 
starch water and laudanum, as an injection into 
the bowel. 

I have often seen prompt relief from an injec- 
tion of the following mixture, repeated three or 
four times in the course of twenty-four hours : 
One cupful of boiled starch water, the water to 
be as much thickened with starch as its use in a 
syringe will permit, to which add two grains of 
the nitrate of silver, and five drops of laudanum. 
The disease so rapidly prostrates the vital pow- 
ers, that alcoholic stimulants, in some form, are 
generally demanded, the best of which is, good 
Bourbon whiskey and French brandy, which 
should be used early in the disease. They not 
only sustain the strength, but relieve the irrita- 
bility of the stomach as well. 

The diet, during an attack of cholera infan- 
tum, must be very simple, the infant to be con- 
fined to the breast, if not weaned, otherwise, it 
may be fed on cold barley water, rice water, 
milk, or wine whey, with brandy or whiskey, 
and later in the disease, as convalescence begins, 
mutton, chicken, and beef broth may be given. 

The great gravity of the disease, its frequent 
fatal termination in a few hours, the rapid sink- 
ing of the vital powers, from the profuse and 



106 CHOLERA INFANTUM. 

frequent discharges, the necessity for the most 
prompt and decided measures of relief, all call 
for skillful attention, and it need hardly be said, 
that no time should be wasted in trifling or ex- 
perimenting, or adopting the theory of this 
friend, or that old woman, or such and such a 
one, who used this and that. If you know just 
what to do, do it, if not, send for some good 
physician, and do as he directs you. 



PNEUMONIA, OR INFLAMMATION OF THE 
LUNGS. 



Pneumonia, inflammation of the lungs, or 
lung fever, as it is variously called, may occur 
at any period of life, yet it is not so common in 
early infantile life, as it is in children a few years 
of age. It often comes on independent of any 
other disease, and at other times it is consequent 
upon some other affection. 

The disease may develop gradually, especially 
when it depends upon some other disease as the 
exciting cause ; or it may come on suddenly, 
with cough, hurried and difficult breathing, and 
great heat of skin. More frequently, hoAvever, 
it is preceded for a short time, by symptoms of 
a common cold. There is no well marked chill, 
as in grown people, but a sense of chilliness, and 
sometimes convulsions. The general appearance 
of ihc child, is that of one out of health ; fretful, 
restless, feverish, thirsty, pulse rapid, face flushed 



108 PNEUMONIA. 

breathing frequent, with a moaning sound on 
expiration of the air from the lungs, and the 
countenance indicating suffering. Soon after 
the disease sets in, cough comes on, which at first, 
is usually a dry, irritating, painful cough, and 
sometimes attending with vomiting. Bowels are 
apt to be constipated, tongue coated white, the 
infant breathes with the mouth open, and if at 
the breast, will not nurse more than a moment 
before it will stop to get a full breath. In the 
first stage of the disease, the general array of 
the symptoms, is as follows : Child is dull, sleepy, 
fretful, if aroused, the body is hot, the extremi- 
ties cold, the face pale, with a dark hue around 
the mouth often, pulse very rapid, the nostrils 
dilated, owing to the difficulty of breathing. 
The rapidity of breathing often reaches thirty 
or forty times per minute, and in severer cases, 
has been known to reach sixty. The red colored 
sputa, so generally noticed in the lung fever 
of older persons, is absent in children, simply 
because they are unable to raise it, and swallow 
it instead, or occasionally throw it up in the act 
of vomiting. The onset and progress of the 
disease, can readily be detected by the sounds in 
the lungs, but only by the educated ear of the 
physician, who has accustomed himself to such 



PNEUMONIA. 109 

examinations, so that the description of these 
sounds would be of no value in domestic practice. 

In the mild, and more favorable cases, a gen- 
eral improvement takes place in the first week, 
or ten days. The pulse and breathing are less 
rapid, the cough is much looser, and less irrita- 
ting, the countenance presents a more natural 
appearance, there is increased appetite, and the 
child manifests a desire for his accustomed play- 
things. The convalescence is generally gradual, 
and a cough more or less severe, will often re- 
main for several weeks. 

In fatal cases, the pulse grows more frequent, 
and weaker, the breathing more and more diffi- 
cult, and as death approaches, the face and 
extremities become quite cool, with profuse 
cold perspiration. In the last stages of the dis- 
ease, abscesses not unfrequently form in the 
lungs, the matter from them escaping into the 
pleural cavity, or between the membranes that 
envelop the lungs and the walls of the chest, 
gives rise to pleurisy. The disease in children, 
is quite apt to attack both lungs, while in people 
of middle and adult life, it seldom attacks but 
one. Pneumonia in itself, is a serious disease, 
and is rendered much more so, by the various 
complications with other affections to which it 
10 



110 PNEUMONIA. 

is liable, such as bronchitis, pleurisy, abscesses, 
&c, and the best of care, close watching, constant 
attention, on the part of the nurse, as well as 
the best resources of the medical attendant, is 
demanded in these cases. 

The following general course of treatment 
may be pursued, and in all the milder class of 
cases, will doubtless suffice : 

In the primary form of the disease, where it 
comes on independent of any other affection, 
and there is difficulty of breathing, with threat- 
ened suffocation, emetics may be given, to expel 
the mucus from the throat and air passages. 
The following emetic will answer ; Syrup of 
ipecac, one ounce ; pulverized ipecac, seven 
grains ; mix and give the child a teaspoonful or 
two, frequently, until vomiting ensues. At the 
same time a mustard paste should be applied to 
the chest, and after it is removed envelop the 
whole chest with thick dry flannel, or what is 
better, make an oil silk waist, or jacket, and 
have the child wear it next to the skin. It 
keeps the heat and moisture of the body from 
escaping rapidly, and protects the body from 
cold and sudden changes of temperature. 

When the skin is hot and dry, tincture of 
digitalis, or tincture of aconite, may be given 



PNEUMONIA. Ill 

after the following formula : Tincture of aconite 
or tincture of digitalis, five drops ; wine of ipecac, 
thirty drops ; syrup of squills, one drachm ; 
simple syrup, an ounce and a half; mix and 
give one teaspoonful every three or four hours, 
to a child a year old. Tincture of veratrum 
viride, in doses of one drop every three hours, 
to a child five years of age, will be very useful, 
but the remedy is too powerful for use, except 
its effects are to be watched by a medical man 
who knows its effects and how to regulate them. 
When there are violent fits of coughing, espec- 
ially at night, Dover's powders may be given 
as follows : Dover's powder, four grains ; white 
sugar, two teaspoonfuls ; mix thoroughly, and 
give the infant what can be placed upon the 
point of a pocket-knife, every two or three hours. 
The following mixture may be used instead : 
Laudanum, six drops ; syrup of squills, one 
drachm ; simple syrup, two drachms ; water, 
two ounces ; mix and give in teaspoonful doses 
every two hours. 

The solution of the acetate of ammonia, or 
spirit of mindererus, as usually prepared in drug 
stores, is a useful remedy for allaying the fever 
heat of the skin, and it may be given in doses of 
half a teaspoonful in a little water, every four 



112 PNEUMONIA. 

hours, to a child one year old. The bowels 
should be acted upon by some laxative, if con- 
stipated, and warm baths, or stimulating lini- 
ments applied to the chest, with friction, will be 
beneficial. 

Children of five years of age and older, often 
require more powerful and active remedies, to 
produce the same effect. For instance, if a child 
five years of age, with lung fever, has a trouble- 
some cough, with difficult breathing, the follow- 
ing formula of Dr. J. Lewis Smith's of New 
York, will be found to answer an excellent pur- 
pose : Sulphate of morphia, one grain; tartrate 
of antimony, one grain ; syrup of tolu, four 
ounces ; mix and give in teaspoonful doses, every 
three or four hours. If there is great difficulty 
of breathing, owing to the intensity of the fever, 
the following mixture may be given : Tincture 
digitalis, sixteen drops; tincture veratrum viride, 
three drops ; wine of ipecac, one teaspoonful ; 
syrup of tolu, two ounces ; mix and give one 
teaspoonful every three or four hours. Chil- 
dren of a weakly, scrofulous constitution, thin, 
pale-faced, require a tonic course of treatment, 
and to such may be given the following prepar- 
ations : Quinine, eight grains ; white sugar, half 
a drachm ; mix and make six powders, giving 



PNEUMONIA. 113 

one twice a clay; or, carbonate of iron, eight 
grains ; white sugar, one drachm ; mix, and 
make eight powders, and give one morning and 
night. One or two teaspoonful doses of wine 
may be given several times during the twenty- 
four hours, and a nourishing diet, that is easily 
digested, should be employed, such as beef tea, 
chicken, mutton and oyster broth, milk, wine 
whey, etc. 

The temperature of the room should be mod- 
erately warm, air moist and fresh, while extremes 
of either heat or cold, are to be avoided, by 
keeping the temperature of the sick room as 
even as possible. Sometimes the breathing 
becomes slow and labored, the circulation torpid, 
when the child turns bluish or purple in the 
face, in which event, stimulants, like brandy, 
camphor, carbonate of ammonia, lavender, etc., 
are useful. The following mixture will answer : 
Tincture camphor, one drachm ; simple syrup, 
two ounces ; tincture lavender, one drachm ; 
mix and give teaspoonful doses every hour. 
Or the following mixture : Carbonate of ammo- 
nia, with syrup of senega, in the proportion of 
one-half drachm of the former, to two ounces 
of the latter ; mix and give teaspoonful doses 
every two hours. Another formula is as follows : 

10* 



114 PNEUMONIA. 

Carbonate of ammonia, twenty-four grains ; tinc- 
ture bloodroot, twenty-four drops ; syrup senega, 
two drachms ; extract liquorice, one -half drachm; 
water, two ounces ; mix and give a teaspoonful 
every three or four hours, to a child two or three 
years old. 

Dr. Jackson of Boston, recommends the fol- 
lowing mixture to allay the troublesome cough 
in this disease : Olive oil, one-half ounce ; syrup 
of squills, half an ounce ; mucilage gum acacia, 
half an ounce ; paregoric, one drachm ; mix and 
give in teaspoonful doses every three or four 
hours, to a child two or three years of age. 
Children in disease, especially any disease involv- 
ing the lungs, should have their position changed 
often ; and infants should be taken up often and 
carried about, and not be left to lie on their backs 
for a great length of time. The foregoing is the 
general course of treatment to be pursued in 
perhaps the generality of cases. Where com- 
plications arise, a change, or modification of 
treatment, will be required. As it is impossible, 
or improbable, that these should be detected by 
any one but the physician, the treatment neces- 
sary in such instances, will no doubt be left for 
him to suggest. 



WHOOPING COUGH. 



Whooping cough is emphatically a disease of 
children, and one of the most frequent of infan- 
tile disorders. It is a contagious disease, due to 
specific causes, yet the real nature thereof is not 
clearly understood. The disease is marked by 
three stages, viz : catarrhal, with symptoms of 
common cold ; second, stage of convulsive cough ; 
third, the stage of decline. 

The appearance of a child coming down with 
whooping cough, is that of a person with a severe 
cold in the head. The eyes will often be injec- 
ted, or blood shot, there is frequent disposition 
to sneeze, discharges from the nose, and more 
or' less cough. At this stage, there is nothing 
unusual about the cough, but the pulse and 
breathing are more rapid than in health. These" 
symptoms of cold in the head gradually improve, 
and no trouble or sign of disease remains, except 



116 WHOOPING COUGH. 

a continual cough. The cough increases in 

CD D 

severity after a while, and the peculiarities of 
the disease begin to show themselves; the cough 
now comes on in spasms, and during each attack 
the child will turn red, almost purple in the face, 
and the whole body is convulsed with the vio- 
lence of the coughing. Each attack of the 
cough is made up of several short expirations of 
air from the lungs, continuing till the lungs are 
almost emptied of air, when a loud, long inspir- 
ation, or influx of air into the lungs takes place, 
which causes the peculiar sound or whoop. The 
whoop is quickly followed by cessation of the 
cough, and a feeling of great relief. 

Sometimes one spasm of coughing will be 
followed by several others in quick succession, 
until the child vomits, and throws up some thick 
mucus. Not unfrequently the spasm will amount 
almost to suffocation, and it seems almost impos- 
sible for the child to regain its breath. The 
veins about the head and neck become much 
congested and swollen, and the eyes almost seem 
to start from their sockets, the nose often bleeds, 
and the contents of the bladder and bowels are 
sometimes forcibly expelled. 

The spasms of coughing may come on every 
fifteen or twenty minutes, but sometimes there 



WHOOPING COUGH. 117 

will be an interval of an hour or more. Infants 
often manifest great dread of the approaching 
spasm, wearing an expression of anxiety upon 
the countenance, often look up to their mother, 
holding fast to her, or, if old enough to be about 
the house, will throw away their playthings and 
make preparations for the attack by holding on 
to a chair, or anything offering support. The 
spasms last from a quarter to a whole minute, 
and during this time there is often as many as 
fifteen or twenty forcible expirations, or succes- 
sive fits of coughing, and Trousseau, a French 
author, has observed as many as fifty per minute. 
At the close of the spasm, if the cough is not 
complicated with any other derangement, the 
symptoms improve, the temperature of the body 
is lowered, the pulse is less frequent, and the 
breathing becomes quite natural. 

The cough in the second stage, is much more 
frequent in one case, than in another, there being 
no regularity about it, and the cough is apt to be 
more severe and violent where there are long 
intervals between the attacks. During the 
height of the disease, it is estimated, that there 
is, on the average, about one spasm of coughing 
every hour, although the attacks may recur at 
longer or shorter intervals. 



118 WHOOPING COUGH. 

The general course of the disease is about as 
follows : The cough increases in violence till 
about the third week of the second stage of the 
disease, or the thirtieth, or thirty-fifth, day from 
the onset of the disease, and then continues with 
almost no change, for some time. The cough is 
usually more troublesome by night than during 
the day, and it is readily excited by any mental 
excitement, or bodily exertion. The ordinary 
duration of the second stage of the disease, is 
from thirty to sixty days, though it may be longer 
or shorter, and it is followed by the third stage, 
that of the decline of the disease, which contin- 
ues two or three weeks, or much longer if there 
is any complication with other diseases. The 
most frequent complications which take place in 
this disease are as follows : In the younger 
children attacked, especially if the cough comes 
on while teething, convulsions, spasms of the mus- 
cles of the throat are common, the spasm begin- 
ing during, or directly after the spasm of cough- 
ing. The convulsions are owing to congestion, 
or fullness of the blood vessels of the brain, the 
congestion being caused by the determination of 
blood to the brain during the act of coughing. 
The severity of the convulsion can be determined 
by noticing the readiness with which conscious- 



WHOOPING COUGH. 119 

ness is restored. If full consciousness is promptly 
restored, it is safe to say that there exists no 
very serious congestion of the brain ; but if 
stupor, drowsiness, or a semi-conscious state con- 
tinues, serious disturbance of the brain may be 
suspected, and death anticipated. 

Dr. Copeland says, that in all cases of whoop- 
ing cough, where there are chills, followed by 
burning heat of skin, pain in the head, with 
unusual redness, or paleness of the face, redness 
of the eyes, with a fixed, brilliant, peculiar ap- 
pearance of them ; torpid bowels, irritability of 
the stomach ; an aversion to light and noise ; 
drowsiness or languor, grinding of the teeth, 
sudden twitchings or shocks of the body while 
asleep ; rolling or tossing of the head, with 
piercing screams, irritation of the brain exists, 
which will soon pass into organic disease, followed 
by stupor, insensibility and death. 

Another frequent complication associated with 
whooping cough, is that of bronchitis, and pneu- 
monia, especially if the disease comes on in 
cold weather. Bronchitis is attended with in- 
creased frequency of the pulse and breathing, 
the heat of the skin is much greater, and the 
danger from this complication is in proportion to 
the difficulty of breathing. In infants the 



120 WHOOPIXG COUGH. 

smaller bronchial tubes may become involved, 
producing capillary bronchitis, which is a very 
dangerous disease. Dr. Tanner saj^s, that unless 
the bronchitis is severe, it will only be noticed 
in the commencement that the child is feverish, 
and that the breathing is increased in frequency, 
especially during the intervals between the 
spasms of coughing ; but as the disease increases, 
the disturbance of the general health becomes 
well marked, the breathing difficult and rapid, 
pulse quick, with high fever, and the general 
symptoms of bronchitis, become fully and clearly 
developed. 

Dr. Alderson, and Dr. Grailly Hewitt, declare, 
that when whooping cough proves fatal, it in- 
duces catarrhal inflammation of the bronchial 
tubes, attended with collapse of a portion of the 
lungs, by which air is excluded therefrom. 
Pneumonia is not so frequent a complication as 
bronchitis, but is said to attend whooping cough 
more than any other disease, except measles. 
Whatever complications arise, whether they be 
lung fever, bronchitis, or any other of an inflam- 
matory nature, they seem to lessen the violence 
of the spasms of coughing, and as the inflammation 
subsides, the cough increases in severity. The 
disease may also be complicated with derange- 



WHOOPING COUGH. 121 

ment of the stomach and bowels, as shown by a 
heavily coated tongue, offensive breath, swollen 
belly, and unnatural passages from the bowels. 
If these symptoms continue for any length of 
time, fever follows, the cough becomes more 
frequent, the breathing more rapid and difficult, 
the child wears a peculiar expression of counte- 
nance, and is constantly picking at the bed- 
clothes, there is greater loss of flesh, and if the 
disease progresses, effusion into the cavities of 
the brain is apt to result. 

In considering the treatment of whooping 
cough space will not allow mention of the long 
catalogue of remedies that have had special and 
peculiar virtues accorded to them, and their cer- 
tain curative influences, for there have been 
about as many different remedies extolled for 
this disease as there have been individuals afflicted 
with it. As the disease is essentially nervous in 
its character, remedies designed to act upon the 
sympathetic nervous system, through the nerve 
centers, will be found most effectual in affording 
relief, except it be in the first stage of the dis- 
ease, when other remedies will be required. 

In recommending the course to be pursued in 
the treatment of whooping cough, 1 shall exclude 
as comparatively useless, the thousand and one 

11 



122 WHOOPING COUGH. 

drugs that have been more or less extolled for 
their virtues, and give the general plan of 
treatment which has been adopted, and carried 
out, by the best and most experienced medical 
men of the past and present. 

The great object of treatment is to prevent 
any other disease setting in, to allay the violence 
of the spasms, and to maintain the patient's 
general health and strength ; therefore, all rem- 
edies of a weakening or depressing nature, 
should be studiously avoided. In the first stage 
of the disease, should there be much bronchitis, 
or difficulty of breathing, counter irritation to 
the chest, such as friction, with camphorated oil, 
aqua ammonia, spirits of camphor, equal parts, 
the chest to be completely wrapped in oil silk 
afterward. Gentle laxative medicines to operate 
upon the bowels, as citrate of magnesia in solu- 
tion, castor oil, or rhubarb and magnesia, should 
be given. Remedies to promote expectoration 
are also required, and the following formula of 
Dr. West's will be found useful for this purpose : 
Wine of ipecac, ten minims ; wine of the tartrate 
of antimony and potassa, thirty minims ; com- 
pound tincture of camphor, twenty minims; 
almond mixture, seven drachms ; the whole to 
be mixed and given in two teaspoonful doses 



WHOOPING COUGH. 123 

every four hours, to a child a year old. Should 
there be much wheezing, owing to the air pas- 
sages being obstructed with mucus, an emetic of 
ipecac once or twice a day will relieve the diffi- 
culty, although it must be borne in mind, that 
too much emesis is very prostrating, and injuri- 
ous effects might follow. Later in the disease, 
when the cough assumes its spasmodic character, 
Dr. West has great faith in hydrochloric acid, 
the following formula being the one used by 
him : Dilute hydrochloric acid, four minims ; sim- 
ple syrup and distilled water, each seven drachms ; 
mix and give teaspoonful doses every six hours, 
to a child nine months old. The effects of this 
remedy need to be watched, to see that it be not 
continued too long, nor any injurious effects 
follow its use. 

Sometimes the child will be quite comfortable 
during the clay, but when night comes on, the 
cough grows very troublesome by its frequency, 
in which case, small doses of Dover's powder 
with extract of hemlock, is recommended by 
Dr. West ; the following is his formula : Dover's 
powder, one-half a grain ; pulverized extract of 
hemlock, one grain ; powdered cinnamon, two 
grains; white sugar, four grains; mix and make 
one powder, and give it at bed-time, to a child 



124 WHOOPING COUGH. 

two years old, and in smaller doses to younger 
children. The most effectual remedies, and 
those most in use at the present day, are, bro- 
mide of potassium, bromide of ammonium, hy- 
drochloric acid and belladonna. Trousseau and 
Guersant, celebrated authors, physicians of large 
experience in the treatment of children's dis- 
eases, speak of belladonna properly administered, 
as being very effectual, so also does Schaeffer, 
and Goelis, who are men of great ability and 
wide reputation. Trousseau prepared pills con- 
taining one-fifth of a grain of the extract and 
one-fifth of a grain of the powder, and gave one 
in the morning, on an empty stomach. If the 
attacks of coughing improved, and were less 
severe, the same dose was given each day ; but 
if no improvement was noticed two pills were 
given on the following morning, then the next, 
and so on, till a noticeable effect was produced. 
The dose which he found to relieve the symptoms, 
he directed to be continued for six or eight days, 
and then, if improvement continued, he directed 
the dose to be lessened by one pill daily, thus 
giving only one pill a day. 

Dr. J. L. Smith of New York, prepares the 
extract of belladonna in one grain pills, and if 
the patient be an infant a year or so old, one 



WHOOPING COUGH. 125 

pill is dissolved in eight teaspoonfuls of water, 
and if three years old, in four teaspoonfuls of 
water, and the mixture is to be given in tea- 
spoonful doses once a day, or even two or three 
times daily if needed in order to produce an 
effect, and as in case of the pills, the dose which 
affords relief, is to be continued for a week or 
more. 

Trousseau sometimes used atropia, instead of 
belladonna, and Brown Sequard stated before 
the United States Medical Association, that the 
duration of whooping cough, or the spasmodic 
character of it, might be reduced to a few days, 
by using atropia in sufficient quantities to pro- 
duce its peculiar poisonous effects, even produc- 
ing delirium for two or three days. It is, how- 
ever, a medicine to be given only by the 
physician, and belladonna, though used much in 
domestic practice, should not be given to chil- 
dren by any one not familiar with its use, and 
the effects produced, and who can not tell by 
the symptoms manifested, when the patient is 
under the full influence of the drug. 

Dr. Gibbs and Professor Harley of London, use 
the bromide of ammonium. Professor Harley 
gives one grain of the bromide of ammonium 
three times a day, to a child one year old, and 

11* 



126 WHOOPING- COUGH. 

increases the close one grain, for every additional 
year of the child's age. 

Dr. Ritchie, physician to the Royal Edinburg 
Hospital for sick children, says, that in his 
opinion, the remedy appears most effectual when 
the child is over two years of age. He gives 
from three to twelve grains, in divided doses, 
every eight hours. Belladonna is considered the 
best in the early stage of the disease, and bro- 
mide of potassium, with bromide of ammonium, 
or iodide of potassium, in the advanced stages. 
Bromide of potassium, is believed to have more 
control over the spasms of coughing, than any 
other remedy. It may be given in doses of one 
grain every three or six hours, to a child one 
year old. The following formula is a convenient 
one for use : Bromide of potassium, sixteen 
grains ; simple syrup, one-half an ounce ; cara- 
way water, two ounces ; mix and give one tea- 
spoonful every three or six hours, to a child one 
year old. 

Dr. J. Lewis Smith of New York, mentions a 
case where a child had twenty convulsions 
within forty-eight hours, who recovered by the 
use of the bromide and iodide of potassium, two 
grains of each being given every two or three 
hours. 



WHOOPING COUGH. 127 

Dr. Dillnberger of the Vienna Medical school 
recommends the following formula, where there 
is much congestion of the brain in whooping 
cough, and tendency to convulsions : Extract 
of belladonna, two grains ; oxide of zinc, two 
grains ; white sugar, one drachm ; mix and 
divide into eight powders, and give one, two 
or three times a day, to children from six to 
ten years of age, the dose to be reduced for 
younger children according to age. Where 
the child raises a purulent, profuse secre- 
tion, an astringent remedy may be required, 
and for this purpose, alum, tannin, or sugar of 
lead may be given. If tannin is used, the 
following formula will answer : tannin, seven 
grains ; white sugar one drachm ; mix and make 
eight powders, and give one every three or four 
hours in a little water. Sugar of lead may be 
given as follows : Sugar of lead one grain ; 
white sugar, one drachm ; mix and make eight 
powders, and give one powder every four hours, 
the dose answering for children at the breast. 
Where the paroxysm of coughing is very severe 
and prolonged, some physicians make the child 
inhale chloroform soon as there are any indica- 
tions of the attack, and so prevent, or shorten 
the spasm. During the paroxysm of coughing, 



128 WHOOPING COUGH. 

the infant must be held, and the mucus which 
is coughed up must be removed from its mouth. 
Dr. Dillnberger of Vienna, says that severe 
paroxysms of whooping cough may be relieved 
by laying a cold dressing on the lower part of 
the breast bone, and cold water frequently 
applied has the same effect. When convulsions 
occur, cold applications to the head, warm foot- 
baths, and laxatives, if the bowels are inactive, 
will be required. 

Many are the remedies that are highly valued 
in domestic practice, among which is the follow- 
ing mixture : Cochineal, one-half a scruple, 
carbonate of potassa, one scruple ; white sugar 
one drachm ; water, four ounces. The dose of 
the mixture for a child one year old, is a dessert- 
spoonful three times a day. Change of air is 
often beneficial, and in cases of whooping cough, 
where no other trouble is associated with it, and 
the weather is warm and pleasant, benefit will 
be derived by "taking the child out into the open 
air daily; but if the weather be cold or damp, it 
should not be allowed. The diet should be well 
regulated and should be such as is easily digested 
and nutritious. Everything tending to excite 
the child must be avoided, and the child's head, 
whether it be asleep, or awake, should always be 



WHOOPING COUGH. 129 

elevated, for if it lies with its head low, it will 
aggravate the cough. 

Although the great majority of the children 
affected with whooping cough recover, any case 
is liable to become complicated with some other 
disease which may render it fatal ; it is therefore 
very important that every case should be care- 
fully watched, to notice the first signs of 
approaching danger, and so be prepared to 
resist it. 



CROUP. 



Few children escape this, one of the most 
prevalent, as well as the most serious, and fatal 
diseases of early life. Croup consists of an acute 
inflammation of the larynx and trachea, or wind 
pipe,, which rapidly increases in severity, termi- 
nating in the formation of a false membrane 
upon the inflamed surfaces, which fills the wind 
pipe, and renders breathing difficult, or impossi- 
ble, according to the extent of the membranous 
deposit. It is most frequent in the first two or 
three years of life, and decreases in frequency 
as age advances. 

The most frequent causes of the disease are, 
exposure to sudden changes of temperature, as 
from a warm to a cold room, or taking a child 
from a warm room into the street on a cold day, 
or being exposed to currents of air, or change of 
dress, the child being dressed much warmer at 



CROUP. 131 

one time than at another. Location has much 
to do with it; low, damp places, situated near 
ponds and rivers, always favoring the progress 
of the disease. Swallowing substances of any 
kind that irritate the throat, give rise to it in 
children very susceptible to the disease. 

Croup usually manifests itself in one of the 
following ways : By a hoarseness, or huskiness 
of the voice, which is noticed in coughing, and 
which continues for several clays, or until some 
fresh exciting cause, as sudden change of tem- 
perature, kindles up the inflammation. Exposure 
to cold, or damp, at such times, which checks 
perspiration, is sure to give rise to alarming 
symptoms, as greater or less difficulty of breath- 
ing, troublesome cough, fever, etc. The other 
way in which the disease often shows itself, is 
by a sudden and violent attack, with almost no 
warning of the approaching difficulty. Life is 
in danger from the beginning of the disease, and 
if its rapid progress be not arrested death will 
soon follow. But in whatever way the disease 
comes on, its most frequent time for showing 
itself is in the latter part of the evening, or 
towards morning, doubtless owing to the cold 
and damp atmosphere of the night, and the 
greater relaxation of the system. Now, what 



132 croup. 

are the symptoms of this disease ? So well 
marked and prominent are they that it would 
seem to be no difficult task to detect the disease, 
and yet many cases are called croup, which lack 
the essential characteristics of the malady. One 
of the first and surest signs that croup is coming 
on, is a peculiar, hollow, sonorous sound, or 
hoarseness,- when the child attempts to cough, but 
which at this time does not affect the voice. 
This state of things may continue for a longer 
or shorter period, and at the beginning of the 
attack, the circulation, breathing, and the appe- 
tite, are not much affected, the child usually 
appearing comfortable and cheerful. The hands 
are frequently noticed to be cold, the face paler 
than usual, and the skin often presents a cold 
appearance during the premonitory stage. The 
cough is short, dry, hollow, and if anything is 
raised, it is thin, whitish, and in small quantities. 
After these symptoms have continued for a time, 
a sadden change often takes place, which may 
prove fatal in a few hours, or continue on for a 
longer or shorter time, with final recovery. We 
now notice increased hoarseness, which affects the 
voice, the cough is more frequent, with longer 
attacks, and each effort is attended with greater 
exhaustion and difficulty of breathing ; the face 



ceoup. 133 

becomes flushed during the attacks of coughing, 
the circulation rapid, child is often drowsy, and 
falls into frequent, but disturbed sleep, from 
which it is awakened by a violent cough and 
distress in breathing. 

If the child is old enough, it raises itself, or 
elevates its head, in order that it may breath 
easier. At this stage of the disease, -the cough 
is attended with more or less secretion of mucus 
in the throat and air passages, and attempts to 
raise it become more frequent and prolonged, 
so much so at times, as to threaten strangulation. 
The child becomes more and more exhausted in 
its efforts to get relief, and throws itself back as 
if in despair, but instantly springs up again as 
if avoiding suffocation. The child can not lie 
down, it throws its head forwards and backwards, 
trying to gain some position which will afford 
some relief from the painful efforts at breathing. 
At this period of the disease, the face instead of 
being red, flushed, is of a dark, livid, bluish color, 
the lips present the same appearance, the gums 
are pale, and the tongue is of a dark color, the 
skin is covered with cold perspiration, the pulse 
is frequent, fluttering and contracted, the heart 
pulsates violently, and the muscles of the neck 
and chest are called into play, to carry on 
12 



134 croup. 

breathing;. The couedi now becomes more fre- 
quent, there is loss of voice, thirst is torment- 
ing, the countenance presents an anxious ap- 
pearance, the eyes are shining with peculiar 
brilliancy, and the little sufferer soon expires, 
unless relief is jn'ocured, by means of medica- 
tion, or surgical operation, the latter sometimes 
rescuing the patient from death, even at- the 
eleventh hour. 

The symptoms, which are here given in 
detail, are those that usually attend true mem- 
braneous croup, that is to say, where there 
is a deposit of false membrane on the mucous 
surface of the air passages, obstructing them so 
that tlie ingress 'and egress of air is much im- 
peded. 

There are other forms of the disease, like 
common croup, without the deposit of false 
membrane, which is known as false, or spas- 
modic croup, the trouble being caused by the 
spasm of the glottis, preventing the entrance of 
air into the lungs. In these cases, the symp- 
toms are very much modified, the disease is less 
severe, and the treatment required of a different 
nature ; which will be alluded to after consider- 
ing the treatment of true membraneous croup. 
In a disease so sudden in its development, so 



croup. 135 

rapid in its progress, so fatal in its consequences, 
no time should be lost in. obtaining relief, and 
the most reliable and prompt means should be 
employed for this purpose. 

The treatment of croup must be energetic, for 
relief must be obtained soon, or it may be too 
late. Before the disease is fully developed, the 
child, having simply a moderate, ringing cough, 
should be carefully watched, placed in a warm 
bath for ten or fifteen minutes, and then be con- 
fined to the bed, the air of the room at the same 
time being kept warm and moist by the genera- 
tion of steam. Afterward, if any difficulty of 
breathing manifests itself, and the cough still 
being rough and hoarse, an emetic should be 
given, for which purpose the following mixture 
will suffice : Wine of antimony, one-half an 
ounce ; wine of ipecac, two drachms ; water, one 
ounce ; mix and give one teaspoonful every 
ten minutes, until the desired effect is produced. 
Another convenient formula is as follows : Pul- 
verized ipecac, ten grains ; white sugar, one 
drachm; mix and divide into twelve powders, 
giving one every fifteen minutes, till vomiting 
ensues. Emetics are useful. in the premonitory 
stages of croup, because they promote the secre- 
tion of mucus, and are attended by more or less 



136 croup. 

vomiting of this substance. They remove from 
the larynx, by the forced expiration caused by 
their action, any albuminous, or fibrinous sub- 
stance, which, till now, is in a soft semi-liquid 
state, but which is likely to become organized 
into false membrane. 

The depressing effect of emetics in the earlier 
stages of the disease, is not injurious, but 
care must be exercised to see that too much 
prostration does not attend their use. Where a 
very prompt emetic is desired, tartar emetic 
may be given as follows : Tartar emetic, one 
grain; compound syrup of squills, one ounce; 
mix and give one teaspoonful every ten minutes, 
till emesis follows. Ipecac is the best emetic for 
children at the breast, or under two years of 
age. Early in the disease, before much inflam- 
mation exists, hot water, persistently applied by 
means of a sponge, or flannels, to the throat and 
chest, will frequently relieve the severity of the 
symptoms. The cloths should be re-appliecl 
every few minutes, in order to keep up the 
temperature, the practice to be continued for 
twenty minutes or half an hour, when a general 
perspiration often sets in, the cough is relieved, 
as well as the difficulty of breathing and hoarse- 
ness, and frequently a quiet sleep follows. After 



ceoup. 137 

an emetic has had its effects it is often desirable 
to maintain a feeling of nausea for some time, 
for which purpose, use this mixture : Chlorate 
of potash, one drachm ; wine of tartrate of anti- 
mony and potassa, one drachm ; wine of ipecac, 
half a drachm ; syrup of lemon, three drachms ; 
water, three ounces ; of this mixture give a des- 
sert-spoonful every three hours, to a child two 
years old. Dr. Smith of New York, and many 
other physicians of large experience in the treat- 
ment of children's diseases, speak highly of the 
chlorate of potassa, or soda, and muriate of 
ammonia, as a remedy for this disease. 

The following is Dr. J. Lewis Smith's formula 
for their use : Chlorate of potash, one drachm • 
muriate of ammonia, two scruples ; simple syrup, 
one ounce ; water, two ounces ; mix and give one 
teaspoonful every twenty minutes or half an 
hour in severe cases, and once in an hour or two 
in mild cases. Inhalation of steam, is a valuable 
adjuvant, in the treatment of croup, the moist 
air coming in contact with the inflamed surfaces, 
promotes expectoration, and renders the cough 
looser. Steam may be readily produced by put- 
ing hot irons or bricks in a shallow dish of 
water, or by pouring water on heated surfaces, 
or by keeping two or three kettles continually 

12* 



138 croup. 

boiling on the stove. The addition of a little 
unslacked lime to the water, has been found to 
be beneficial. The temperature of the room 
should be kept uniform, but not too high, and 
all exposure to cold or currents of air, must be 
avoided. 

Allusion has been made to emetics, and those 
were mentioned that operate mildly, without 
much depressing effect ; but in the most serious 
forms of the disease, where the air passages are 
filled with membraneous deposit, the most prompt 
and powerful emetics are demanded, and those 
should be selected that are the least depressing 
in their effects. Sulphate of copper will best 
answer these indications, and it may be used as 
follows: Give a dose of one grain, dissolved in 
a little water, and repeat it every twenty min- 
utes, till vomiting results. If there are any signs 
of exhaustion, and the membrane has been re- 
noved so that the child can swallow, beef tea, 
milk, wine whey and alcoholic stimulants should 
be given, in order to keep the patient's strength 
up as well as possible. Local treatment, both ex- 
ternal and internal, should be resorted to, for 
much relief is obtained by these means. Some of 
the best authorities speak highly of cold water as 
an external application in croup, among whom are 



croup. 139 

Professor Peaslee of New York, Dr. Dillnberger 
of Vienna, and others. It may be applied by 
wringing out flannels in cold water, or by pieces 
of ice, or finely powdered ice, in oil silk bags, 
placed around the neck. These cloths, or bags, 
need to be continually applied, changing as often 
as they grow warm, for if reaction is allowed to 
take place, and warmth ensues, the inflammation 
will increase rather than diminish. Cold appli- 
cations agree best with robust, full-blooded chil- 
dren, but in all cases where these applications 
render the child more uneasy, restless and un- 
comfortable, hot applications must be substituted, 
and these may consist of heated bags of fine salt, 
boiled potatoes, well mashed, or poultice of flax- 
seed and mustard, equal parts. Oil silk should 
be placed over these poultices, to keep the heat 
and steam from escaping, and at the same time 
protect the patient's clothing from dampness. 

It is a very common practice, in domestic 
circles, to bathe the throat and chest with olive 
oil, or to bind a piece of salt pork on the throat, 
and it frequently answers a good purpose. In- 
stead of the latter, equal parts of aqua ammonia, 
camphorated oil, and chloroform liniment, mayjje 
frequently and thoroughly applied with flannel, 
the neck to be well protected with oil silk after 



140 CROUP. 

each application. Internal applications to the 
throat are demanded, in order to soften and 
remove the membraneous deposit from the 
throat, and many are the remedies which have 
been used for this purpose. Among the most 
common are, nitrate of silver, dilute hydrochloric 
acid, dilute nitric acid, chlorate of potassa, 
muriate of iron, or a mixture of the two last; 
but other remedies have been found that are 
more effectual. Professor Smith of Bellevue 
Hospital, New York, says : " Of late years, three 
other remedies have been used for topical treat- 
ment of the throat, which appear to be more 
effectual in removing the false membrane, and 
controlling the inflammation. One is liquor of 
the subsulphate of iron, the other carbolic acid, 
and the third, bromine. The sulphate of iron is 
best employed with glycerine, in the proportion 
of one part to four, as follows : Liquor of the 
subsulphate of iron, one drachm ; glycerine, half 
an ounce. Carbolic acid should be used diluted 
with water, the following formula answering the 
purpose : Carbolic acid, one drachm ; water, 
six ounces. Bromine is used in combination with 
bromide of potassium, a solution of which may 
be made after this formula : Bromine, two 
drachms ; bromide of potassium, sixteen grains ; 



CKOUP. 141 

water, one ounce. From twenty-four to forty 
drops of this solution, should be added to an 
ounce of water, for application to the throat. " 

Although it is a confession of weakness, it is, 
nevertheless, too true, that all these remedies, 
and remedial measures frequently prove unavail- 
ing, the disease progresses, there are violent 
paroxysms of choking, with great difficulty of 
breathing, signs of exhaustion, or fainting, and 
coma, or lethargic state, appears, the bodily 
strength is not sufficient to remove the collected 
secretions and false membrane with the cough- 
ing, or even perhaps with the vomiting, and 
death soon closes the painful struggle for life, 
unless the last weapon of defense, the knife, 
proves successful. 

The operation of tracheotomy, or opening the 
wind pipe, has its advocates and opponents, but 
as all cases must inevitably die without it, where 
all other means have failed, they can no more 
than die if the operation is performed. It is 
looked upon by parents as a cruel procedure, 
but the fact is, the operation is a great source of 
relief to the child, while it does live, and it is a 
question whether the operation should not be 
performed for this purpose alone, in cases where 



142 croup. 

recovery is utterly hopeless. M. Trousseau, 
the great advocate for tracheotomy in the last 
stage of croup, states that in four years time, he 
operated twenty-four times in private practice, 
with fourteen cures, and two hundred and six- 
teen times at the Children's Hospital, with forty- 
seven recoveries. 

Professor Jacobi of New York, in a statement 
published in the American Journal of Obstetrics, 
for May, 1868, says, that out of 166 cases oper- 
ated on by himself and Drs. Krackowizer and 
Voss of New York, 39 recovered and 127 died. 
Other statistics could be furnished, but these 
are enough to convince any one of the prac- 
tical utility of the operation as a means of sav- 
ing life. 

The details of the operation are not called 
for in a work of this kind, for no one but the 
physician could perforin it. 

In all cases of croup, after recovery has taken 
place, the utmost precaution must be taken to 
guard the child against cold, currents of air, and 
excitement of any kind, for it takes but little 
exposure to cause a relapse of the disease, 
which is more apt to prove fatal than the first 
attack. 



croup. 143 

In spasmodic, or false croup, anodynes and 
antispasmodic remedies will be the most service- 
able, such as belladonna, valerian, musk, assa- 
foetida, camphor, bromide of potassium, chloro- 
form, and other remedies of like nature. 



SCARLET FEVER. 



Scarlet Fever, is also called scarlet rash and 
scarlatina. It is called scarlet fever, on account 
of the peculiar red, or scarlet color of the skin. 
The disease is both contagious and infectious, 
and is attended with fever, inflammation of the 
mucous membrane of the mouth and throat, and 
an eruption which appears upon the skin about 
the second day of the fever, and continues till 
about the fifth day. The disease often affects 
the glands about the neck and throat, which 
increase in size, and occasionally sivppurate, 
discharging matter freely. 

Scarlet fever is much more prevalent in Winter 
and Spring, than in Summer and Autumn. Most 
authors classify the disease into three varieties, 
according to the kind, and severity of the symp- 
toms, as follows : Simple scarlet fever, or the 
regular form of the disease ; scarlatina anginosa, 



SCARLET FEVER. 145 

or irregular form of the disease, where the throat 
and glands of the neck become involved in the 
course of the disease ; and malignant scarlet 
fever. Like most other fevers, the simple form 
of this disease is generally ushered in by a dis- 
tinct chill, or feeling of chilliness, fullness of head, 
and headache, high fever, vomiting, prostration 
and sometimes delirium. The pulse is often 
from one hundred and ten to one hundred and 
twenty per minute ; the skin is hot, face flushed, 
and in many cases there is twitching of the 
muscles, and more or less stupor. Vomiting 
usually takes place during the first twenty-four 
hours, or before the appearance of the rash, and 
when it continues for a longer time than usual, 
or with unusual violence, it indicates a severe 
attack of the disease, and one attended with 
more than common danger. 

After these symptoms have continued for 
twelve or twenty-four hours, the rash begins to 
appear, showing itself first about the ears, upon 
the face, neck and shoulders, in indistinct patches, 
which gradually fade. These patches unite 
, rapidly, extend, and in a few hours the whole 
body is covered. About this time a degree of 
redness and swelling appear in the throat, the 
same appearance extending to the tongue. The 

13 



146 SCARLET FEVER. 

skin is now excessively hot, there is great thirst, 
the pulse is very rapid, and the rash gives rise 
to an itching, or burning sensation, which adds 
much to the discomfort of the patient. Cough 
frequently attends the disease, though usually 
slight. In the common form of the disease, the 
symptoms as here detailed, continue without 
much change for five or six days, when the fever 
begins to decline, the heat of the body to dimin- 
ish, and the rash fades away, so that convalescence 
begins at the first of the second week, or before. 
During the second week the rash becomes very 
indistinct, the redness and swelling about the 
throat disappear, the tongue regains its natural 
appearance, the appetite returns, and a general 
look of health manifests itself. 

During convalescence the skin desquamates, 
or peels oft*, commencing on the face and neck, 
and so on over the whole body, the process last- 
ing for several days. Such is the general course 
of scarlet fever in its most common form ; while 
in scarlatina anginosa, or the form of the disease 
which affects seriously the glands of the neck 
and throat, the symptoms are more violent. , 
There is more headache, with delirium, intoler- 
ance of light, greater heat of skin, and more 
prostration. In a day or two there is stiffness 



SCAKLET FEVER. 147 

of the neck, uneasy sensation in the throat, with 
hoarseness and difficulty of breathing, caused by 
the swelling of the tonsils and palate. As the 
inflammation extends, the fever increases, the 
skin grows hot and dry. The eruption does not 
come on with its usual regularity, not appearing 
as early as usual, and instead of extending over 
the whole body, it comes out in patches here 
and there, which soon disappear, and partially 
reappear after uncertain intervals. 

As the eruption fades away about the fifth or 
sixth day, the fever and inflammation of the 
throat abate, but the soreness of the throat often 
continues for several days after the rash and 
fever disappear. Sometimes this variety of the 
fever assumes a still more serious form, when 
there is an acrid discharge from the nose and 
ears, with deafness, and the glands of the neck 
often swell up, and suppurate, discharging freely. 

In the third variety spoken of, viz., malignant 
scarlet fever, the symptoms are much more vio- 
lent than in the other varieties. The fever is 
of a typhoid character, and attended with much 
greater prostration ; there is great disturbance 
of the brain, followed by irritability, restlessness, 
and delirium, which is sometimes violent, and at 
other times a low muttering kind, the patient 



148 SCARLET FEVER. 

constantly talking in a low voice, picking at the 
bed-clothes, or imaginary objects; the tongue 
is of a dark color, the teeth are covered with 
sordes, the pulse is very rapid and everything 
indicates the gravity of the disease. The erup- 
tion is very irregular in its appearance, disappears 
in a few hours, and reappears the second time, 
in the course of the disease, and it is at first of 
a pale color, but is soon changed to a dark, livid 
hue. 

Scarlet fever is very apt to leave the health 
permanently impaired, therefore the greatest care 
and watchfulness is necessary, both during the 
course of the fever, and for sometime after con- 
valescence has taken place. 

Among the many disorders caused by scarlet 
fever, are a variety of scrofulous affections, as 
scrofulous ulcers, disease of the eyes, enlarge- 
ment and suppuration of the glands of the neck, 
disease of the scalp, inflammation of the inter- 
nal ear, with profuse discharges therefrom, 
often terminating in the destruction of the in- 
ternal ear, and consequent deafness. But the most 
serious difficulty resulting from scarlet fever, is 
inflammation of the kidneys, resulting in dropsy. 
The dropsical trouble usually comes on between 
twent}' or thirty days after the commencement 



SCARLET FEVER. 149 

of the fever, and it is much the most common 
after the mild form of the disease. This fact is at- 
tributed to the greater carelessness of the patient 
in mild cases, exposure to cold, the exposure 
checking the action of the skin, so that the 
poison, instead of passing off through the perspi- 
ration, is thrown back into the blood, and is 
eliminated by the kidneys, which causes the 
inflammatory trouble, and attendant dropsy. 
Sometimes serious disturbances of the lungs and 
digestive organs, result from this disease. 

In the mild form of the disease, but little 
treatment is required beyond attention to diet, 
and general hygienic measures. Some mild 
remedy to promote perspiration, is useful, and 
for this purpose the following mixture may be 
given : Sweet spirits nitre, three drachms ; wine 
of ipecac, two drachms ; syrup of ginger, one 
ounce and a half; mix and give one teaspoonful 
every three hours, to a child from four to six 
years of age. This formula will also anwer the 
purpose well: Liquor of the acetate of ammonia, 
two ounces ; two teaspoonfuls to be given every 
four hours in a swallow or two of water. If the 
bowels are constipated, some gentle laxative will 
be useful, as the solution of the citrate of 
magnesia, given in wine glass doses, oft repeated. 
13* 



150 SCARLET FEVER. 

To relieve the restlessness, a warm foot bath is 
good, or sponging the whole body with tepid 
water, and bathing the head with cool water, 
bay rum, and the like. The sick room should 
be well ventilated, allowing no currents of air to 
reach the patient, but allow plenty of cooling 
drinks, and light, but nutritious diet. 

Where the disease is more violent in its be- 
ginning, with high fever, delirium, and great 
prostration, more vigorous treatment will be 
demanded. The application of cold w r ater, by 
putting the patient in a bath tub, pouring on 
cold water, immediately afterward placing the 
patient in bed, warmly wrapped in flannels, 
thereby inducing copious perspiration, is highly 
recommended by good authorities. The wet 
sheet, or packing, as it is called, is a convenient 
method of applying cold water ; after the patient 
has remained in the wet sheet for an hour or so, 
free perspiration is produced, and then the 
patient is to be wiped thoroughly dry, placed in 
bed, the wet clothes at the same time being 
exchanged for dry. If called for, the process 
may be repeated, until the great heat of the body, 
and the dryness of the skin, is overcome. In 
very young children, while the cool applications 
would be equally useful, the shock which they 



SCARLET FEVEE. 151 

cause, would not be so well tolerated, therefore, 
tepid water should be used instead. Where there 
is much debility and prostration, small doses of 
wine frequently repeated, or occasional doses of 
brandy, should be given to support the strength, 
together with beef tea, and broths. 

Medicines should be given internally, to allay 
the fever, and to promote the removal of the 
fever poison from the blood, and for this purpose 
various remedies are useful, and among them, 
perhaps there are none better than a mixture of 
chlorate of potash and hydrochloric acid, in the 
following proportions : Chlorate of potash, four 
grains ; hydrochloric acid, half a drachm ; water, 
half a pint. A tablespoonful of this mixture 
may be given several times during the day. 
When the patient is constantly drowsy, delirious, 
the circulation torpid, skin of a dark, dusky hue, 
stimulants must be given freely. Wine whey, 
egg-nog, milk punch, are convenient methods, 
or mixtures, for administering stimulants to chil- 
dren. Carbonate of ammonia, is a quick, volatile 
stimulant, and is a remedy much used, and very 
effectual in sustaining the strength of the patient. 
Dr. Smith of Bellevue Hospital, of New York, 
recommends its use with iron, in the following 
formula : Carbonate of ammonia, half a drachm ; 



152 SCARLET FEYER. 

citrate of iron and ammonia, half a drachm; 
simple syrup, two ounces ; mix and give a tea- 
spoonful every three hours, to a child five years 
of a^e. 

Often there is great itching of the skin, so as 
to greatly annoy the patient, which is best 
relieved by rubbing fresh lard into the skin, 
olive oil, or what is much more agreeable, glyc- 
erine. In cases where the rash appears but im- 
perfectly, the patient should be placed in a 
warm bath, to which a little mustard may be 
added, and in cases with much delirium, wake- 
fulness, picking at the bed-clothes, anodynes will 
be required. Bromide of potassium may be 
given in five grain closes, to a child five years of 
age, the dose to be repeated every hour, till 
quiet is restored. I have seen the happiest 
results from the use of bromide of potassium, in 
combination with the compound spirits of ether, 
in cases of extreme wakefulness and restlessness. 
Ten drops of the spirits of ether may be given, 
with five grains of the bromide of potassium, the 
dose to be repeated every hour or two, as the 
case demands, until sleep is secured. I have 
known this to succeed, when opium in its various 
forms failed altogether, and it has the advantage 
of being comparatively harmless. The throat 



SCARLET FEVER. 153 

trouble often proves serious, therefore the throat 
should be carefully watched from the outset of 
the disease. The glands of the neck not only 
swell and suppurate, but the inflammation is at 
times so severe, that gangrene, or mortification 
and sloughing of the parts, takes place, which is 
apt to result fatally. 

If the throat is found to be much inflamed and 
swollen, gargles should be used, and if the child 
is too young to use gargles, then local applica- 
tions should be made with a brush. 

A gargle like the following will suffice in mild 
cases : Solution of the chloride of soda, one 
ounce ; glycerine, one ounce ; water, one ounce ; 
mix, when it is ready for use, without dilution. 
One of the best preparations for applications to 
the throat is, however, a mixture of the tincture 
of the chloride of iron and chlorate of potash, 
after the following formula : Tincture of the 
chloride of iron, two drachms ; chlorate of potash, 
two drachms ; glycerine, one ounce ; rose water, 
three ounces ; mix and apply to the throat 
thoroughly every two hours. Often in young 
infants the throat becomes so much stopped up 
with mucus that breathing is rendered difficult, 
when the throat must be well swabbed out, and 
whatever is used for a swab, should be dipped 



154 SCARLET FEVER. 

into a mixture of chloride of soda, yeast, or 
hydrochloric acid and honey. For the ulcera- 
tions of the throat, nitrate of silver, twenty 
grains to the ounce of water, is serviceable. 

Liniments, lotions and poultices, are all more 
or less useful in relieving the soreness of the 
throat, applied externally. A poultice of hops 
and powdered flaxseed, or a liniment like the 
following may be used : Camphorated oil, chloro- 
form liniment, aqua ammonia, each an ounce, 
mix and rub the throat well with the mixture 
three or four times daily. The common domes- 
tic practice of applying slices of salt pork, with 
mustard sprinkled upon the surface that is ap- 
plied to the throat, is by no means a bad or 
useless one, but on the contrary, it is a very good 
as well as a convenient one, and when used, should 
be kept constantly applied. When the glands 
of the neck are much swollen, with tendency to 
suppuration, tincture of iodine should be applied, 
or painted on the parts twice daily, the applica- 
tion to be made with a camel-hair brush. 

In the malignant forms of the disease, every 
means must be resorted to to support the patient's 
strength, for this type of the fever is always 
attended with marked and severe prostration 
from its commencement. Beef tea, egg-nog, 



SCAELET FEVER. 155 

wine or brandy, either with or without carbonate 
of ammonia, as the exigencies of the case de- 
mand, should be given at short intervals, night 
and day, for convulsions and stupor, or coma, 
are much less liable to occur, if the strength of 
the patient is well supported. 

After the child has recovered from the fever 
it should be kept in doors, and not be exposed 
to currents of air for some weeks afterwards, for 
as has been before stated, this exposure to cold 
and getting chilled, is the frequent cause of the 
kidney disease, that so often attends the fever, 
and the dropsy that succeeds it. When there is 
any evidence that the kidneys are involved, and 
dropsy is resulting, profuse perspiration should 
be excited, and diuretics should be given to in- 
crease the flow of urine. These effects may be 
accomplished by placing the patient in a warm 
bath for a few minutes, after which, put the 
patient to bed, and surround him with bottles of 
hot water, or generate steam under the bed 
clothes, by placing underneath them a pan of 
water, into which drop heated stones, bricks, 
flat-irons, or anything that comes handy. Diu- 
retics and diaphoretics must be given to increase 
the action of the skin and kidneys, for which 
purpose small doses of Dover's powder may be 



156 SCARLET FEVER. 

given, together with teaspoonful doses of spirits 
mindereri, or solution of the acetate of ammonia, 
the close to be repeated every three or four 
hours. Sweet spirits of nitre and solution of 
acetate of ammonia may be given in combination, 
as follows : Solution of acetate of ammonia, two 
ounces ; sweet spirits of nitre, one ounce ; jnix 
and give one teaspoonful in a wine glass of 
water every four hours, to a child five years of 
age. The acetate of potash is a remedy much 
in use, and is very good as a diuretic. It may 
be given in five grain doses, dissolved in a little 
simple syrup and water, the dose to be repeated 
every four hours. The dropsical effusion is 
rapidly diminished by the use of cathartics, which 
produce copious and watery stools, such as citrate 
of magnesia, colocynth and Rochelle salts. 
Elaterium is a prompt and powerful cathartic, 
producing abundant watery stools, and may be 
used in this manner : Dissolve one grain of the 
powder in two ounces of glycerine, and give 
teaspoonful doses once in four hours, until the 
desired effect is produced. 

The remedies mentioned above are generally 
successful in lessening, if not entirely removing 
the dropsical trouble in its acute stage, but where 
the difficulty assumes a chronic form, other 



SCAELET FEVEE. 157 

remedies of a different nature will be more 
effectual. Many drugs have had peculiar virtues 
ascribed to them ; but among the most service- 
able in dropsy following scarlet fever, may be 
'mentioned, tincture of the chloride of iron, 
iodide of potassium, syrup of the iodide of iron, 
and the compound solution of the iodide of 
potassium, of the London Pharmacopoeia. The 
latter remedy has been found highly useful by 
Dr. E. Copeman of Norwich, England, given in 
one-half, or one drachm doses, as the case 
demands, repeated every four hours. The com- 
pound liquor of iodine, of the United States 
Pharmacopoeia, (Lugol's solution,) is to be used 
in much smaller closes, viz., two drop doses, 
gradually increased to five, and repeated every 
five hours, each dose to be given in a wine glass 
of water. If the tincture of the chloride, or 
syrup of the iodide of iron are used, they may 
be given in doses of ten drops in a wine glass of 
water, repeated every five hours. The syrup of 
the iodide of iron may be given in combination, 
as follows : Syrup iodide of iron, one ounce ; 
iodide of potassium one scruple ; mix and give 
ten drops in a wine gla^s of water every four or 
six hours. The great majority of d ropsical cases, 
will yield to the course of treatment here marked 
14 



158 SCARLET FEVER. 

out, if all due precautions are taken, and the 
remedies judiciously applied. 

Belladonna is a remedy which has been much 
used, and highly extolled, both as a remedy, and 
a preventive, but the results have not at all 
satisfied the expectations of its advocates. 

The discharges from the nose and ears often 
caused by this fever, have been treated of in the 
chapter on inflammation of the ears, and so need 
not be enlarged upon here, more than to say that 
they should be attended to at once, in order to 
prevent disastrous consequences, and whatever 
complication arises during the progress of the 
fever, it should receive "prompt attention. In 
a word, there is no disease where so many ill 
effects follow ; and it requires great care, and 
constant watching, to guard against changes of 
temperature, improper exposure, injurious diet, 
and these precautions should be heeded long 
after the patient has left the bed. 



MEASLES. 



This is an eruptive disease, prevailing princi- 
pally in infancy, and childhood, although it may 
attack people of any age. It usually occurs but. 
once in a life time, yet there are well authenti- 
cated cases of a second attack. The disease 
prevails to its greatest extent in the winter and 
spring, the cold weather seeming to favor the 
spread of the disease, which is true of most of 
the eruptive disorders of a contagious nature. 
The disease usually manifests itself from seven 
to fourteen days after exposure, and it is ushered 
in by a sense of chilliness, debility, heat of skin, 
thirst, especially the first day. 

The fever is quite high from the first, and 
especially about the time the eruption appears, ' 
which is the third or fourth clay from the begin- 
ing of the attack, and there is most always a dry 
hollow cough, more or less hoarseness, sore 
throat, pain in the chest, and difficulty of breath- 
ing. The eyes are red, watery, lids swollen, 



160 MEASLES. 

there is sneezing, free discharge from the nostrils, 
and a general appearance of a cold in the head. 
The eruption most always appears first, on the 
face and neck, and spreads from thence over the 
whole body. Sometimes the eruption instead 
of coming on in this regular form, appears in 
large red spots of irregular size and shape. 

The color of the eruption is usually very red 
for the first three or four days, after which it 
assumes a brownish color, and then gradually 
disappears. After the eruption fades away the 
cough often increases in severity, attended with 
expectoration, and not unfrequently, lung fever 
attends the disease, which is an unfavorable 
complication. 

The shape of the eruption in measles, is cres- 
ent, a half-moon shape, and is raised but a little 
above the surface of the skin. Occasionally the 
eruption shows itself but imperfectly, disappears, 
then comes out again, in which case internal 
troubles are more likely to result, and whenever 
the eruption is dark, or black in color, the disease 
is called malignant, or black measles, and is 
generally fatal. 

Bronchitis and pneumonia are often caused by 
measles, and diarrhea usually comes on during 
the course of the disease and is sometimes quite 



MEASLES. 161 

severe. Sore eyes, inflammation of the ears, 
with discharges therefrom, very frequently result 
from measles. The disease in the great majority 
of cases, is not attended with much danger, yet, 
as in scarlet fever, a variety of secondary disor- 
ders are apt to follow, and constant watch and 
care is necessary, until all traces of the disorder 
have disappeared. 

In deciding whether the eruptive disease is 
that of measles, there need be no doubt, when 
the characteristic odor of the disease is noticed, 
which is a strong, mousy, musty smell, unlike 
that attending any other disease. In mild cases 
little or almost no treatment is demanded, beyond 
keeping the patient in a warm room, and giving 
warm drinks to excite perspiration, and confin- 
ing the patient to light, nutritious diet. 

To promote the appearance of the eruption, 
various drinks and medicines have been used, 
among which are saffron, sage, catmint, and 
pennyroyal tea. Dover's powder in from two 
to ten grain doses, according to age, will answer 
the same purpose. Spirits of mindereri may be 
given in teaspoonful closes, with twenty drops 
of the sweet spirits of nitre in a little water, 
every three or four hours. When there is much 

debility, with a weak constitution, the eruption 

14* 



162 MEASLES. 

is often tardy and imperfect in its appearance, 
which calls for stimulants, as small doses of wine 
or brandy, and in cases assuming the malignant 
type of the disease, with a dark purplish erup- 
tion, both alcoholic stimulants, and the most 
nutritious animal broths will be required to 
support the patient's strength. The cough which 
always accompanies the disease sometimes is 
severe and persistent, and care needs to be taken 
to see that pneumonia or lung fever does not 
result, as is frequently the case if neglected. 
Small doses of the camphorated Dover's powder, 
say two or three grains every four hours, to a 
child from three to fi ve years of age, or small 
doses of the wine of antimony, or w r ine of ipecac, 
with tincture of opium, or elixir paregoric. The 
following mixture will be found useful for the 
cough : Elixir paragoric, syrup of squills, syrup 
of ipecac, each one-half an ounce; compound 
spirits of ether, two drachms ; tincture of vera- 
trum viride, ten drops; mix and give one tea- 
spoonful every four or five hours, to a child of five 
years, lessening or increasing the dose according to 
age. If difficulty of breathing manifests itself, and 
the symptoms indicate disturbance of the lungs, 
the chest should be covered with a bag filled 
with fine salt, or meal, heated, so as to keep the 



MEASLES. 163 

chest warm, or a liniment containing an ounce 
each of spirits camphor, olive oil, water of 
ammonia, and chloroform lininent should be 
applied. A good sized mustard paste of good 
strength, will answer the same purpose. The 
chest needs to be well protected from cold, by 
means of an oil silk covering, and the cough 
mixtures, with alcoholic stimulants, good nu- 
tritious diet, all need to be continued until the 
croup and lung trouble entirely disappears. The 
same precautions are necessary for some time 
after measles, that are so important after cases 
of scarlet fever. 



MUMPS. 



Mumps consist in inflammation and congestion 
of the parotid gland, situated in front of, and 
below the ear. The disease commences with 
tenderness and swelling of the gland, the swelling 
gradually increasing until it fills the hollow space 
below the ear, or behind the angle of the jaw, 
and extends forwards upon the cheek, and 
downwards upon the neck, to a greater or less 
degree, involving often the gland, situated 
beneath the chin. Sometimes only one, at other 
times both sides will be affected, and in some 
cases, there will be but little swelling, while in 
others, the whole face and neck will be swollen 
to a considerable size, and attended with so much 
soreness and stiffness that it becomes almost 
impossible to open the jaws, so that the patient 
has to be confined to liquid nourishment. There 



MUMPS. 165 

is more or less fever present, which lasts for three 
or four days. When the swelling has reached its 
full height it remains stationary for two or three 
days, then declines, and gradually disappears in 
the course of a week or ten days. Occasionally 
the swelling suddenly disappears from the face, 
when it will be found to have attacked the private 
organs, in the male, and the breasts in the female, 
and on account of this peculiarity of the disease, 
great precautions must be taken to guard against 
cold. The disease, like most others of its class, 
is contagious, and makes its appearance in ten 
or twelve days after exposure. 

But very little treatment is required in this 
affection. The swollen parts may be rubbed 
with warm camphorated oil, or chloroform lini- 
ment, and cotton wool bound on to protect from 
cold. Small doses of Tully's powder may be 
given to promote rest, and perspiration. Mild 
laxative medicines may be given, such as citrate 
of magnesia, teaspoonful doses of the citrated 
kali, seidlitz powders, and the mineral waters. 
If the swelling goes to the private organs in 
the male, or the breasts in the female, warm 
poultices or fomentations, should be applied 
to the parts, when the trouble will soon dis- 



166 MUMPS. 

appear, in most cases. Sometimes the swelling 
can be made to return to the face, by applying 
warm poultices to the face, and stimulating 
liniments. 



VARIOLOID. 



Varioloid is simply small-pox modified by 
vaccination, and presents the same class of 
symptoms, though of course, less severe. 

The disease commences with chills, followed 
by fever, more or less headache, pain in the 
back and groins, usually quite severe, vomiting, 
a sense of dizziness, while in some cases there is 
more or less delirium. About the third or fourth 
day after these symptoms first appear, the erup- 
tion shows itself in shape of little red points, that 
feel quite hard underneath the skin. The erup- 
tion may be quite thick, but frequently there 
are no more than twenty or thirty on the entire 
body. The eruption runs through its natural 
course much sooner than in genuine small-pox, 
and there is not generally any great amount of 
constitutional disturbance, unless it be during 
the premonitory stages. 



168 VARIOLOID. 

But little treatment is required in varioloid, 
beyond keeping the patient in doors, and giving 
light, nourishing diet, cooling drinks, and a mild 
laxative. 



SMALL POX. 



Small-pox is both contagious and infections, 
and is accompanied with high fever, pustular 
eruption, and is one of the most loathsome dis- 
eases that flesh is heir to. The symptoms 
indicating the approach of small-pox, are, a 
decided chill, followed by high fever, vomiting, 
pain in the back and groins, loss of appetite 
and strength, a feeling of general lassitude, with 
free perspiration, pain in the head and vomiting, 
followed the second or third day by the eruption, 
which appears first on the face, forehead, hands, 
and rapidly extends over the whole body. Where 
the eruption is slow in making its appearance, it 
is claimed that the disease will be of a mild form, 
and severe if the eruption comes out early and 
rapidly. 

The eruption first shows itself in minute red 
points, feeling hard and like small shot beneath 



170 SMALL POX. 

the skin, which gradually increase in size, be- 
coming vesicular on the second or third day, 
and at the eighth day, the vesicle will have 
reached its full height, or size, often nearly a 
fourth of an inch in diameter. The base of the 
vesicle is circular, hard, and there is quite a circle 
of red and inflamed skin around it. As the pock 
matures it changes its form, or shape, and 
becomes hollow, or depressed in the center, with 
its outer edge or rim considerably elevated. 
When the eruption appears, the fever, headache, 
pain in the back, and thirst, cease, the appetite 
improves, unless it be in the confluent form, in 
which the fever continues to a greater or less 
extent. 

At the same time the eruption appears upon 
the skin it may appear upon the eyes, in the 
throat, and upon all the mucous surfaces, which 
may terminate in severe and dangerous ulcera- 
tions of the throat and larynx, and ulcerations 
of the cornea, destroying vision. During the 
time the pustules are filling, or during the 
suppurative stage, the fever reappears, and in 
the confluent variety, is very severe, with fre- 
quent pulse, loss of appetite, wakefulness and 
violent delirium, and there is so much swelling 
of the face that the individual could hardly be 



SMALL POX. 171 

recognized by his friends, and the odor from the 
patient at this time is peculiar, and decidedly 
unpleasant. 

As time advances the liquid contents of the 
pustules dries up, and a hard, dry, brown 
crust remains, the pustules drying up first on 
the face, and so on in the order of their appear- 
ance. The crusts begin to be thrown off about 
the fifteenth day of the eruption, and should be 
gone in about three weeks. As the crusts dis- 
appear, the cough, hoarseness, fever, delirium, 
all disappear, patient sleeps better, appetite is 
good, and health is restored. 

The symptoms vary much in severity in dif- 
ferent cases, but the symptoms as they gener- 
ally manifest themselves, are here protrayed. 

Various disorders are liable to be developed 
during an attack of small pox, among which are 
the following : Inflammation and ulceration of 
the eyes, with loss of vision, abscesses, swelling 
and suppuration of the joints, inflammation of 
the private organs in the male, and of the ovaries 
in the female, bronchitis, pneumonia, and some- 
times mortification and sloughing of different 
parts of the body, and inflammation of the brain, 
or its enveloping membranes. This disease, like 
most eruptive and febrile diseases, is self limited, 



172 SMALL POX. 

running a definite course, and in considering 
its treatment, we are to watch the progress of 
the disease, meet the emergencies as they arise, 
and guard against complications as much as 
possible, therefore, the treatment must be pallia- 
tive and expectant. If the disease is uncompli- 
cated and pursuing its natural course, but little 
treatment will be needed, except a laxative to 
begin with, and an occasional sponging with 
tepid water, to allay the fever and heat of skin, 
with an anodyne now and then to procure sleep, 
and supporting the patient's strength with beef 
tea, egg-nog, milk and wine, or brandy if needed. 
The patient may be allowed cooling drinks, like 
lemonade, champagne cider, carbonic acid water, 
or tamarind water. The sick room should be 
kept cool, thoroughly ventilated, and moder- 
ately dark ; the bed clothing should be light, 
and changed as often as circumstances will allow. 
In the. confluent variety, or where the sores or 
pustules run together, there is greater prostra- 
tion of the system, complications are much more 
liable to arise, and there is much more danger of 
a fatal result. If there is troublesome constipa- 
tion, something to act upon the bowels should 
be given. The vital powers of the patient are 
here sorely taxed, and great pains must be taken 



SMALL POX. 173 

to properly support the patient's strength, by 
means of the best and most nutritious animal 
broths, alcoholic stimulants, either with or 
without carbonate of ammonia, as the case may 
demand. 

The heat and itching of the skin is at times 
almost intolerable, and some relief may be ob- 
tained by frequent sponging with tepid water, 
or a weak solution of chloride of soda and water. 
It is desirable as far as possible to prevent 
pitting, and a great variety of means have been 
resorted to for this purpose. 

Eayer, and others, advise breaking up the 
vesicle by means of a fine needle or some pointed 
instrument. Rillet and Barthez speak highly 
of cauterizing the pustules with a stick of nitrate 
of silver, and in order to be successful, it must 
be done early in the disease, as early as the 
second or third day of the eruption. The appli- 
cation of the tincture of iodine is recommended 
by some, and though not preventing it, is said 
to diminish pitting. Another method is by 
excluding light and air, by means of plaster, or 
by applying oil and dusting on some fine dry 
powder. Dr. Smith of Bellevue College, New 
York, uses a powder made of equal parts of sub- 
nitrate of bismuth and prepared chalk, and where 
15* 



174 small rox. 

there are cracks or fissures, he uses nitrate of 
silver, or oxide of zinc in glycerine, in the pro- 
portion of one drachm of silver, or zinc, to the 
ounce of glycerine. Collodion, or a solution of 
gutta percha, is sometimes painted on the ex- 
posed surfaces, which forms a complete coating 
when dry, and quite effectually excludes the air. 

It is the duty of every individual, both for 
their own interest and that of the public, to use 
all consistent and lawful means for preventing 
the spread of this malady, and while I would 
fully endorse all precautionary measures I 
would at the same time urge people not to be 
influenced, or at least, governed, by the wholly 
unwarrantable fears that are often manifested 
during the prevalence of the disease. 

The enervating influence upon the system 
which fear exerts, places the individual in one 
of the best conditions to take the disease, and 
sometimes, it really seems as though all con- 
tagious disorders, like small-pox, cholera and 
yellow fever, thrived best on timid victims, and 
pursued them in hot haste. A case illustrating 
this point, lately occurred on an ocean steamer 
plying between New York and San Francisco, 
Cal. One of the cabin passengers was taken 
down with the disease soon after leaving New 



SMALL POX. 1 i O 

York, and died a few days before reaching his 
destination. As there was a clergyman aboard 
they called upon him to make a prayer, before 
casting the body overboard ; but he could not be 
prevailed upon to appear on deck, and so 
remained in a remote corner of the ship, the 
subject of much scorn and ridicule from the 
passengers and crew. The first person that was 
stricken down with the disease, was this same 
divine, in his secluded retreat, and the passengers 
and crew said it was a judgment sent upon him ; 
but did not fear execute the judgment ? There 
is then wholesome fear, that serves as a protec- 
tion, and unwholesome fear, that invites the 
disease to take hold of you. 

Keeping the body thoroughly cleansed, well 
nourished, apartments you live in w T ell ventila- 
ted, securing your usual rest and perfect digestion, 
are all important protective measures. Vacci- 
nation is, however, the most perfect preventive 
that has yet been discovered, or in all probabil- 
ity ever will be, and this will be fully treated of 
in the succeeding chapter. 



VACCINATION. 



Much has been said both for and against 
vaccination, but there is no denying the fact, 
that it is a great protection against small-pox. 

Statistics collected by Simon and Marson, show 
that of those who contract varioloid, the larger 
the number of vaccine cicatrices, or scars, the 
milder the disease, and the less the proportionate 
number of deaths. In Simon's statistics, of those 
claiming to have been vaccinated, but who had 
no scar, 21 3-4 per cent, died ; of those who 
had one scar, 7 1-2 per cent, died ; of those who 
had two scars, 4 1-8 per cent, died ; of those 
who had three scars, 1 3-4 per cent, died ; while 
those who had four scars, only 3-4 per cent. died. 

These facts so fir as they go indicate the pro- 
priety of vaccinating in several places, and things 
being equal, the system must thereby be brought 
more thoroughly under the influence of the virus, 



VACCINATION. 177 

and consequently be the better protected. The 
common practice is, however, to vaccinate only 
in one or two places, and there are various 
methods of performing the operation, viz., by 
cutting the skin with a point of a lancet, and 
inserting beneath the cuticle a small particle of 
the vaccine crust well softened, so as to be 
readily absorbed ; by use of an instrument made 
for the purpose, the needle or pipe of which is 
inserted beneath the skin, and the liquid virus 
forced suddenly in ; by simply scarifying the 
skin, which consists in making several slight 
incisions or scratches, and rubbing the virus in ; 
and lastly, by scraping the skin with the point 
of a lancet till the blood just shows through, 
and then applying the virus in a state of solution. 
The last two methods are the simplest, safest, 
and most desirable. 

The patent vaccinators, or instruments, which 
suddenly force the virus in, often place the virus 
deep into the cellular tissue, exciting erysipelas 
and causing a hard painful swelling of the arm, 
with large ulcerative sores, that are not only 
very disagreable but difficult to heal readily. 

Every time an instrument is used to vaccinate 
with, it should be well cleansed before repeating 
the operation on another individual. The pop- 



178 VACCINATION. 

ular prejudice against vaccination is, that humors 
and blood diseases are introduced into the system 
by this mean?, and while this may be true, in a 
certain sense, it is not true to the extent gen- 
erally supposed. It is true, that if any person 
has erysipelas, scrofula, or other humors, vacci- 
nation will kindle them up to renewed activity, 
especially while the virus is operating throughout 
the system. Erysipelas and syphilis are the 
most liable of any disorders to be introduced into 
the blood by vaccination, therefore, virus should 
never be taken from any person who has ever 
been subject to either of these disorders, nor 
should virus be taken from any but those who 
have always been healthy, and free from blood 
disorders and hereditary disease. It is safe to 
say, that if the virus is thus selected and prop- 
erly used, no trouble will arise from vaccination. 
In selecting virus for use, the lymph, or matter, 
taken directly from the arm, from the fifth to 
the eighth day of the eruption, is the surest 
and safest. The lymph is often prepared for 
use by inserting quill points into the vaccine sore, 
or pustule, until they are well covered with the 
virus, in which condition they can be kept for 
use for two or three weeks in cold weather. The 
vacine crusts, in order to be good must be of a 



VACCINATION. 179 

dark brown or mahogany color, circular in form, 
with a depression in the center. In preserving 
them for use, they should be wrapped in cotton 
wool and tin foil, then placed in a vial tightly 
corked, so as to exclude the air as much as pos- 
sible. 

Vaccination should be performed the first year 
of life, and it can with propriety be performed 
any time after the child is two or three months 
old, or even much earlier if necessity demands 
it. It was the opinion formerly that one vac- 
cination would suffice for a life time, but the fact 
is established beyond all question of doubt, that 
the protective power of vaccination does grad- 
ually die out, and needs to be repeated, every 
five or seven years. The course of genuine 
vaccination is as follows : No effect is noticed, 
except it be slight inflammation, till the end of 
the third day, when the specific inflammation 
should begin. At this time there will be noticed 
a small red point, at first scarcely visible, hard, 
slightly elevated above the skin, as noticed by 
the touch. This increases, and on the fifth day, 
the skin over the inflamed part begins to be 
raised by a transparent, and thin, watery liquid. 
The vesicle increases in size, and by the sixth 
day, presents a depression in the center, with 



180 VACCINATION. 

considerable swelling around it. On the ninth 
day, the red areola around the sore becomes 
more distinct, and its diameter increases ; the 
color thereof is deep red, there is quite a good 
deal of swelling, the parts being hard, and tender 
to the touch. On the tenth day, when the 
pustule is mature, the inflammation around the 
sore reaches its height, and the heat, tenderness, 
and itching, are such that the child will often be 
fretful, feverish and restless. About the eleventh 
day the inflammation begins to subside, and 
gradually disappears, and the crust falls off 
about the twentieth day. If, as is sometimes 
the case, the vesicle leaves an unhealthy and 
persistent ulcer, a mild healing ointment should 
be applied, as ointment of oxide of zinc, or an 
ointment composed of benzoic acid and oxide 
of zinc. 



CONVULSIONS. 



Convulsions occur in a great variety of 
diseases, beginning at birth, and prevailing to a 
greater or less extent during the first six or 
eight years of childhood, and they depend upon 
a variety of causes. The exciting cause may be 
located in the brain or spinal cord, as congestion, 
inflammation, or some organic disease, and tem- 
porary derangement of the digestive organs, is a 
fruitful source of the difficulty. They are not 
unfrequently traced to the operation of fear, or 
some other mental emotion. 

In nurslings, convulsions are often caused by 
changing the milk with which it is nourished, or 
if confined to the breast, by changes wrought in 
the milk of the mother, due to violent emotion 
of the mother, as anger, fright, or grief. 

If the mother chances to have her courses 
while nursing, it is apt to produce convulsions in 

16 



182 CONVULSIONS. 

the infant at the breast. Constipation, worms, 
dysentery, scarlet fever, teething, brain fever, 
all are frequently attended with convulsions, 
more or less severe. The causes being so numer- 
ous, it is highly important in any and every 
case, to ascertain what the particular cause is, 
where it is located, and treat it accordingly. 

Sometimes the convulsions come on suddenly 
without any warning, then again there will be 
premonitory symptoms for some time before the 
disease becomes fully developed, and in the latter 
case the symptoms indicating the approach of 
an attack, are as follows : there is more or less 
drowsiness, and if the child be disturbed it 
appears very fretful ; the eyes generally have a 
wild, unnatural appearance, sometimes fixed for 
a time on some given object, apparently without 
noticing it ; the sleep is unsound, there is unusual 
heat of the head, the features present a variety 
of expressions, and there seems to be actual 
delirium. Just as the convulsion is to come on, 
the child's thumbs are often drawn into and 
across the palm of the hands, and the child usually 
lies quiet, with its eyes open and fixed, and if 
spoken to takes no notice of anything. The face 
is sometimes pale, at other times flushed, and 
when the cause of the convulsion lies in the 



CONVULSIONS. 183 

brain, the face is marked by streaks, or patches, 
of a flushed appearance, while around them the 
natural color remains. Before the spasmodic 
movements set in, the child often utters a pierc- 
ing scream, which is generally involuntary. 

The convulsive attacks are indefinite in their 
duration, lasting from a few minutes to several 
hours, and even days, and they may be partial, 
affecting only certain muscles or portions of the 
body, while at other times they will be general, 
involving in one convulsive attack the whole body. 
When the whole body is thus involved, the muscles 
of the face and eyelids, the arms and legs, are in 
a state of frequent involuntary contractions, 
followed by relaxation of the spasm. The 
features are much changed in appearance, and 
contorted, the mouth is drawn out of shape, often 
to one side, by the violent contractions of the 
muscles ; the teeth are closed together like a 
vise, the tongue often being bitten severely. If 
the attack continues for any length of time, 
froth pours out of the mouth, not unfrequently 
being tinged with blood, the head is forcibly 
drawn backward, or to one side, the thumbs and 
fingers are forcibly brought together, the fingers 
covering the thumbs. Consciousness is usually 
lost, the head is hot, and the face flushed, though 



184 CONVULSIONS 

as before stated, in some cases, the head will be 
cool and the face pale, owing to different exciting 
causes. The pulse is increased in frequency, 
and the breathing- is also hurried and irregular. 
The contents of the bladder and bowels are 
frequently passed involuntarily during the attack. 
The partial form of the disease affects only cer- 
tain muscles, as those of the face, neck and 
throat. Convulsions last for an uncertain length 
of time, and while they may last for hours, the 
average duration is said to be from five to twenty 
minutes. Unless there is organic disease of the 
brain, or some other important organ, prompt 
relief is usually afforded, and the most violent 
attack will generally prove of short duration. 
As the convulsive attack ceases, the child takes 
a long breath, fills the lungs, lies quiet and 
breathes quite naturally. Some recover in a 
few moments, and seem to suffer no great incon- 
venience afterwards, while others soon recover 
their consciousness, the temperature of the body, 
breathing and the circulation become natural, 
but remain dull and listless for a time, not 
noticing things, and are unable, or not inclined 
to speak, some hours elapsing before all effects of 
the spasms disappear. In many cases, especially 
where the convulsions are caused by some inter- 



CONVULSIONS. 



185 



nal derangement, there will be only one con- 
vulsion if suitable treatment is promptly given, 
while in other cases there may be several con- 
vulsions in 24 or 48 hours, or during a longer 
or shorter time. 

The treatment for this disease must of course 
depend greatly upon the particular cause, which 
should be ascertained as soon as possible. As 
soon as a child is seized with convulsions it should 
at once be put into a warm bath, to which 
mustard may be added, in order to produce some 
irritation of the skin, and at the same time cold 
water should be applied to the head, either by 
cloths clipped in ice cold water, or by placing 
bags of finely powdered ice on the forehead for 
a few minutes at a time. This process quiets 
the nervous system, and tends to relieve the 
congestion of the brain and spinal cord. The 
bath should be continued for fifteen or twenty 
minutes, after which thorough friction, with the 
hand or towel, would be beneficial in equalizing 
the circulation. 

Constipation is quite apt to exist, in which 
case some laxative should be given at once, but 
if the stomach is irritable, so that medicine is 
not well retained, an injection into the bowels 
may be substituted. Soap and water, salt and 

16* 



186 CONVULSIONS. 

water, or water well sweetened with molasses, 
will serve the purpose of an injection, and about 
half a pint should be injected at once, as smaller 
quantities are generally ineffectual, or are apt 
to be. 

Whatever objections may be raised against the 
use of calomel, it certainly is a most valuable 
remedy in convulsions depending upon derange- 
ments of the digestive organs. It may be given 
in doses of one grain of the powder once in five 
or six hours, and followed with fluid extract of 
rhubarb and senna, citrate of magnesia, citrated 
kali, or castor oil, sufficient to act upon the 
bowels. If there is much irritability of the 
stomach, with vomiting, lime w r ater and bismuth, 
or oxalate of cerium may be given. The lime 
water and bismuth may be given after the fol- 
lowing formula : Lime water, two ounces ; bis- 
muth, twenty grains ; mix and give two tea- 
spoonfuls every hour or two, in a wine glass of 
water or milk. 

Warm external applications over the stomach, 
of flannels, poultices, bags of hops, or poppy 
leaves, steeped, will serve a good purpose. In 
cases where the whole trouble is caused by eating 
some indigestible food, or fruit, an emetic should 
be given, in order that the offending substance 



CONVULSIONS. 187 

may be thrown off. Where the convulsive 
attacks come on frequently and severely, it is 
necessary, or at least best, to control them by the 
inhalation of chloroform. Bromide of potassium 
is a remedy highly valued, and much used for 
this affection. It may be given in doses of one 
grain every three hours, to a child a year old, 
and the dose may be increased by one grain, for 
every additional year of the child's age. The 
following formula is a convenient one to adopt 
in using this drug : Bromide of potassium, 
twenty-four grains ; simple syrup, one ounce ; 
peppermint water, two ounces ; mix and give 
teaspoonful doses every three hours, to a child 
a year old. In the severer cases, where drowsi- 
ness, and symptoms of congestion of the brain 
continue for some time after the convulsion, it 
sometimes becomes necessary to apply irritating 
substances to the back of the neck, as mustard 
pastes, blisters, or chloroform, applied with the 
hand, as long as it can be borne. Soaking the 
feet in warm water, and applying drafts of 
mustard, or roasted onions, are sometimes ser- 
viceable. 



INFLAMMATION AND CONGESTION OF 
THE BRAIN. 



Inflammation of the brain and its membranes, 
is a frequent disease of infancy and childhood, 
and one of the most fatal in its consequences. 
It often comes on as an independent disease, 
while at other times it is a sympathetic, or 
secondary disease. The symptoms are well 
marked, and about as follows : At first there is 
a general restlessness, more or less fever, which 
is irregular in its character, the child looks sober, 
is peevish, is slow and languid in its movements, 
and takes but little notice of things which usually 
please. Sometimes it will stop suddenly in the 
midst of its play, and put its hand to its head, 
or place its head in some one's lap, at the same 
time complaining of pain in the head, and of being 
tired and sleepy. There is often a sudden look 
of fear, the child utters a sudden cry, and looks 
strangely, as if not knowing what to do or think. 



INFLAMMATION OF THE BKALNT. 189 

If old enough to walk, the child will often pre- 
sent a peculiar gait, as halting, or dragging of 
one leg. The appetite is variable, generally 
poor, while at other times, or in other cases, it 
will be good, so that the patient will cry for food. 
The stomach is frequently affected through sym- 
pathy, as evidenced by vomiting, and the bowels 
are generally constipated ; the tongue is red on 
its side and tip, and is covered with a white 
coating in the center. The pulse is generally 
quite rapid, often 120 or 130 per minute, the 
child is drowsy but restless, grinds its teeth in 
its sleep, lies with eyes partially open, and starts 
up at every little noise ; the eyes are often sen- 
sitive to light, and in some cases it cannot be 
tolerated at all. As the disease progresses the 
symptoms increase in severity, the face assumes 
an expression of anxiety, or of pain, showing 
great suffering, the head is hot, face flushed, 
the child cannot bear to be disturbed, and lies 
in a dull, sleepy state, and is not inclined to say 
anything when aroused. 

As the disease reaches its third stage, the 
child passes into a state of stupor, picks its nose, 
lips, or at the bed clothes. The head is now hot, 
the face flushed ; the next moment the head may 
be cool, and the face pale j at one time the skin 



190 INFLAMMATION AND 

may be dry and hot, and in a few moments be 
covered with a profuse perspiration. The pulse 
grows small and very rapid, the eye lids but 
partially close, eye balls roll around, and the 
child makes irregular motions with its mouth. 
A sudden attack of convulsions may end the 
scene, or the child may live on for some time and 
waste away, dying from exhaustion. 

These are the general symptoms which attend 
brain fever, or inflammation of the brain, though 
all of the symptoms are not present in any 
individual case, the symptoms varying greatly 
in different cases ; but there are enough of them 
present in most cases, and so characteristic as to 
leave but little doubt regarding the nature and 
location of the disease. 

The disease is a dangerous one, rapid im*its 
progress, and calls for prompt and vigorous 
measures of relief, with constant watching, and 
careful, faithful nursing. 

As soon as the child manifests the first symp- 
toms of uneasiness, or fretfulness, and complains 
of its head, precautionary measures should at 
once be adopted. Everything which tends to 
excite or irritate the child, should be strictly 
avoided. If the bowels are constipated, they 
should be acted upon by injections, or laxative 



CONGESTION OF THE BKAIN. 191 

medicines, for it will not do to let the constipa- 
tion continue. A warm mustard bath with 
thorough friction of the skin, will be useful to 
equalize the circulation, and relieve the head by 
its derivative effect. 

If the patient be teething, the gums badly 
swollen, hot and painful, it may be advisable to 
lance the gums, and relieve the pressure of the 
teeth. Benefit may be derived thus early in the 
disease by applying small blisters behind the 
ears, or on the back of the neck, or by producing 
counter irritation by means of croton oil painted 
on the skin with a small hair brush. 

Children of a weakly scrofulous condition, are 
especially liable to this disease, and such persons 
require a tonic, sustaining course of treatment, 
in Order to render them less liable to the disease. 
The diet in such cases should be simple, easily 
digested and nutritious. Cod liver oil should be 
given in teaspoonful doses, with syrup of the 
iodide of iron, in doses of five or ten drops, before 
each meal. Anodynes are needed after, to quiet 
the irritability and restlessness, and for this pur- 
pose, Dover's powder, syrup of poppies, bromide 
of potassium, laudanum, elixir paregoric, or 
Hoffman's Anodyne, may be given. If the 
symptoms increase in severity, and inflamma- 



192 INFLAMMATION AND 

tion of the brain becomes fully developed, more 
active and vigorous treatment will be demanded. 
The internal remedies recommended are numer- 
ous, but the best effect is obtained from the use 
of iodide of potassium, given in two or three 
grain doses, every two hours, to a child a year 
or two old, the dose to be increased according to 
the age of the patient. When the vomiting is 
severe, it is best to try to relieve it, though it is 
quite apt to prove persistent, as long as the 
irritation of the brain continues. A mixture of 
lime water and bismuth given after the following 
formula, will often be effectual in relieving the 
vomiting : Lime water, four ounces ; sub-nitrate 
of bismuth, two drachms ; mix, and to a half a 
cup of milk, add one-third of the mixture, and 
give a table-spoonful hourly, at the same time 
use warm applications to the pit of the stomach. 
The room should be kept dark and quiet as 
possible ; ice cold cloths should be applied to 
the head, or bags of finely powdered ice, which 
will relieve the head symptoms, and in the most 
serious cases, blisters to the back of the neck, 
may be of much benefit. Alcoholic stimulants 
late in the disease, when there is evidence of 
failing strength and great prostration, will be re- 
quired, but they should be avoided early in the 



CONGESTION OF THE BRAIN. 193 

disease. During the attack, the strength must 
be supported by beef tea, mutton or oyster 
broth, milk, &c. 

The general course of treatment required is 
here given, but what would be serviceable in 
one case, might be ill-adapted to another, and 
as the disease is so grave in its character, so fatal 
in its consequences, no time should be lost in 
summoning the best medical aid to be procured, 
and constant care, with the best possible nursing, 
are equally important. 



HYDROCEPHALUS, OR DROPSY OF 
THE BRAIN. 



This disease consists in an excess of fluid in 
the cranial cavity, which may be external to the 
brain, or in its interior. Children are sometimes 
born with the disease, and in other cases it is 
acquired. It may be acute, running a rapid 
course, or chronic, the child suffering for a long 
time, gradually wasting away to a skeleton, and 
dying at last of exhaustion. Children who are 
born with the disease, do not always have it 
plainly developed at birth, and nothing unusual 
will be noticed for some time, after which, the 
head and features begin to present the striking 
appearance so characteristic of the disease. As 
the dropsical fluid increases within the skull, the 
bones are expanded and are rendered thin, by 
the process of absorption, caused by the pressure 
of the contained fluid ; the scalp is stretched, 
grows tight and thin, and is scantily covered 
with hair ; the veins of the face and head are 



HYDROCEPIIALOUS. 195 

quite prominent, and their whole course can be 
traced in the colorless skin, and the whole head 
is quite elastic from the amount of water within. 
Not long since, the writer was in attendance at 
the birth of a child with hydrocephalus, where 
the skull, or cranial cavity must have contained 
a quart of water, and the bones of the skull were 
so thin and widely separated, that they could be 
moulded into any shape desired. 

Owing to the pressure of the fluid upon the 
bones of the forehead, the eye balls are turned 
downwards, the downward direction increasing 
with the increase of the dropsical effusion. The 
face and features look diminutive in size, on 
account of the disproportionate size of the head. 
During the early stages of the disease the child 
has a fair appetite, nurses well, and digestion is 
quite well performed ; but as time advances, 
evidences of imperfect nutrition of the body be- 
gin to show themselves ; the head increases in 
size, while the rest of the body instead of grow- 
ing, shows signs of wasting and rapid emaciation, 
especially the neck, arms and chest. In the 
last stages of the disease, digestion is very much 
impaired, the stomach becomes very irritable, 
vomiting being a constant symptom, frequently 
attended with diarrhea, and the senses of sight, 



196 HYDROCEPHALOUS. 

smell, and taste, are all affected. If the child is 
old enough to walk, it does so with an unsteady 
gait, and if the fluid accumulates in sufficient 
quantity to compress the brain, the child becomes 
dull, drowsy, and takes but little notice of any- 
" thing, there are frequent spasmodic movements 
of the limbs, the pupils of the eyes act feebly 
and irregular, one often being much more dilated 
than the other. Sometimes there is strabismus, 
or cross-eyes, and as the end draws near, con- 
vulsions set in, followed by a state of stupor, 
soon terminating in death. 

Such is the general course of this disease when 
it goes on to a fatal termination. Not every 
case proves fatal, but the vast majority are 
hopeless cases, nothing whatever having any 
control over them. All that science can do in 
these cases, is to place obstacles in the way of 
the progress of the disease, and prolong life as 
much as possible, and so treatment can be only 
palliative. Any means that will tend to lessen 
the quantity of liquid in the brain, will relieve 
to a certain extent. Medicines to act upon the 
kidneys, increasing the secretion of urine, are 
beneficial, among which are the acetate and 
nitrate of potash, syrup of squills, tincture of 
digitalis, iodide of potassium, and other drugs of 



HTDEOCEPHALOUS. 197 

this class. The nitrate and acetate of potash 
may be given as follows : Dissolve half an ounce 
of potash in eight ounces of water, and give a 
teaspoonful three or four times daily, in a little 
sweetened water. Iodide of potassium may be 
given in one or two grain doses every two hours, 
to a child a year old, and it should be given in a 
little sweetened water. 

If the bowels are inactive, some laxative 
should be given, and a regular action thereof 
secured daily. 

Some recommend strapping the bones of the 
skull together with adhesive plaster, in order to 
prevent their separation, but such a measure 
could hardly afford relief, for as the spreading of 
the bones is prevented, so much greater must be 
the compression of the brain within. As a last 
resort, puncturing the head and drawing off the 
dropsical fluid, is sometimes performed, which 
of course, would have to be entrusted to the 
medical adviser. 

Every child presenting evidences of impaired 
health, feeble constitution, with unusual promi- 
nence and blueness of the veins, should have 
the full benefit of pure air, sunlight, bathing, 
good nourishment, and every hygienic, and san- 
itary measure available. 

17* 



TETANUS AND LOCK JAW OF NEW- 
BORN CHILDREN. 



This is a peculiar malady which manifests 
itself during the first few days after birth, gen- 
erally between the fifth and tenth day, or about 
the time of the separation of the umbilical cord. 
In some countries, and in certain localities, cases 
are very rare, while in hot climates, and in un- 
healthy localities, one-fourth of all children born 
are carried off with the disease, and in certain 
places half the infants have died with it. The 
disease develops very rapidly, and comes on 
wholly unexpected, for a child now healthy, is 
lifeless in a few hours from the time the disease 
first makes its appearance. 

There have been various opinions as to the 
real exciting cause of this disease, but it seems 
to be pretty well established, that it is owing to 
uncleanliness, impure air, atmospheric changes, 
inflammation of the umbilical cord and its mem- 



TETANUS AND LOCK JAW. 199 

branes, and to injuries to the spinal cord, received 
during labor, or after birth. Where the disease 
comes on gradually, it may be often noticed that 
the child is fretful, frequently moans or cries, 
its sleep is unsound, and while asleep, there are 
efforts at smiling. While awake the child is 
restless, throws its limbs about, there is a livid 
circle around the eyes, the discharges from the 
bowels are of a greenish color, and there is a 
great desire for the breast. 

One of the first alarming symptoms noticed 
by the parents, which shows the real nature of 
the trouble about to develop itself, is, that the 
infant is unable to nurse, or manifests much pain 
and hesitation in nursing. The muscles that 
first become contracted and rigid, are those of 
the face, especially the muscles used in the jaws, 
and as the disease extends, involves the muscles 
of the back and limbs. In the early part of the 
disease, the limbs can be bent, the jaws opened, 
but as the disease progresses it becomes difficult, 
or impossible. The jaws become fixed together, 
the tongue presses against the teeth, and froth 
issues from the mouth; the muscles of the neck 
are stiff, contracted, and the head is drawn 
backward and held there ; the fore-arms are bent, 
the thumbs are placed across the palm of the 



200 TETANUS AND LOCK JAW. 

hands, and are held tightly by the fingers, and 
the thighs are drawn up toward the body. 
Sometimes the head and feet are both drawn 
backward, and so stiff is the whole body at times, 
that the child can be lifted by the head and feet 
without the body bending at all. During the 
spasms the features present a very unnatural 
appearance, often much contorted ; the eye lids 
are forcibly shut together, and the lips may be 
either drawn in, or pouting, and the forehead 
and cheeks, are drawn into folds, or wrinkles, by 
muscular contractions, there is at times trembling 
of the limbs, and in cases most fatal the spasms 
come on more and more frequently, until death 
ends the struggle. 

During the attack, the breathing is imperfect, 
the circulation of the blood is much impeded, 
and the skin becomes deep red, almost livid, and 
in fatal cases death usually takes place within 
twenty-four or forty-eight hours. 

Treatment amounts to but little in this disease, 
when it has made any progress. Some recom- 
mend that the cord be dressed, and a clean cloth 
applied daily, with frequent bathing. Others 
advise the application around the cord, of the 
spirits of turpentine, or tincture of opium and 
spirits of wine. Glycerine and solution of car- 



TETANUS AND LOCK JAW. 201 

bolic acid, or per manganate of potash, may also 
be used as an application to the cord. These 
are to be used as means of prevention, rather 
than curatives, for if anything is to be accom- 
plished, it must be before the disease is actually 
developed. 

In administering medicines during the attack, 
but little can be given by the mouth, on account 
of the jaws being fixed, and if medicine is placed 
in the mouth it is forced back by the muscular 
contractions of the mouth and throat. The 
remedies used for this malady are numerous, 
among which are the following, by different 
physicians : Dr. John Furlonge of St. Johns, in 
a favorable case, gave one drop doses of lauda- 
num, alternately with two grains of Dover's 
powder every three hours. Dr. Woodworth also 
gave one drop doses of laudanum every three 
hours, and Dr. Eberle, one-sixth of a drop hourly. 
Dr. Furlonge, in giving Dover's powder, com- 
bined with it five grains of sulphate of zinc. Dr. 
Eberle, gave with his one-sixth of a drop doses 
of laudanum, six drops of the tincture of assa- 
foetida. Chloroform has been much used, the 
child inhaling it till the spasm is relieved, and 
its iipplication renewed with each succeeding 
spasm. 



202 TETANUS AND LOCK JAW. 

The loss of flesh and strength is very rapid, 
and wine, whiskey, or brandy, is needed to keep 
up the strength of the patient ; but instead of 
giving by the mouth, it will frequently have to 
be given by injection. If the navel presents 
evidences of inflammation, it is advisable to 
apply poultices, and blisters applied to the navel 
sometimes afford relief. A warm foot bath, and 
friction of the spine with some stimulating lini- 
ment will be beneficial. Dr. Beclnor advises the 
application of bags of ice to the spine, or a 
douche of cold water. The blowing of ether 
spray upon the spine is sometimes substituted 
for the ice, which has the advantage of being 
more easily and conveniently applied. 

In the great majority of cases medicines do 
no good, and the disease when once developed, 
rapidly progresses to a fatal issue. 



EPILEPSY. 



Epilepsy is a frequent disease of childhood, 
the attacks of which come on suddenly, with 
loss of consciousness and sensibility, with spasms, 
followed with more or less stupor. Sometimes 
the patients, instead of falling suddenly down, 
have some warning of the approaching attack, 
such as a peculiar sensation of the body, as of a 
stream of cold water running on them, or currents 
of warm air blowing on them, and of insects 
creeping upon the skin, these sensations com- 
mencing at the extremities of the limbs and 
ascending upward till they reach the head, when 
the spasm comes on. Some have spectral illusions, 
and imagine they see strange and curious objects. 
There is headache, dizziness, imperfect vision, 
and confusion of .thought, and as the attack 
begins, the child often utters a loud piercing 
shriek, and immediately falls senseless to the 



204 



EPILEPSY. 



floor, in violent convulsions. The muscles are 
contracted, the hands are firmly shut together ; 
there is grating of the teeth and frothing at the 
mouth ; the eyes are fixed and partly open ; the 
breathing is loud and difficult ; the face is flushed, 
and for a moment it seems as though the child 
would suffocate, when the spasm suddenly yields, 
and the patient often lies for some time insensible, 
seemingly in a quiet sleep. The fit lasts for an 
indefinite time, sometimes for half an hour or 
more, though it is usually of short duration, con- 
tinuing for only five or ten minutes, and fre- 
quently, the subjects of epilepsy are able to get 
up and walk in a few moments afterward. The 
fits recur at variable intervals, it may be for 
months, and again, they may come on almost 
daily. 

The causes of this disease are somewhat obscure. 
It is said to be owing in some cases to malforma- 
tion of the bones of the head, and it is true that 
attacks frequently follow blows, or falls, upon 
the head. The diet, exercise and mental pursuits 
have their influence in causing the disease, and 
it sometimes depends upon the irritation of the 
nervous system, produced by teething, especially 
while getting the second set. 

In seeking to remedy this affection, the first 



EPILEPSY. 205 

step should be to ascertain the cause, and en- 
deavor to remove it. The medicines which have 
been highly extolled for their peculiar effects 
upon this malady, are almost numberless, but 
there are comparatively few that are effectual 
in curing, or relieving the disease. 

The latest medical authorities point to bella- 
donna and bromide of potassium, as the most 
effectual remedies. The latter may be given as 
follows : Bromide of potassium, one scruple ; 
white sugar, half an ounce ; annise water, two 
ounces ; mix and give teaspoonful doses, every 
three hours, to a child a year old, increasing the 
do?e to twice or three times the amount if the 
child is six or seven years old. 

If belladonna is used, one-eighth of a grain 
of the extract, may be dissolved in an ounce of 
water and given in teaspoonful doses every three 
or four hours. During the attack, throwing cold 
water upon the face, will often arouse the patient, 
or a bottle of ammonia, held to the nostrils will 
sometimes do it. 

The diet of patients subject to epilepsy, should 
be light and nourishing, but little meat should 
be taken, arrti everything that unduly excites 
the child, or fatigues it bodily or mentally, should 
be guarded against. 

18 



CHOREA, OR ST. VITUS DANCE. 



This disease is not common in children at 
a very early age, but it is quite frequent from 
five to fifteen years of age. It consists in loss 
of power of the will, to control the movements 
of the muscles of voluntary motion, giving rise 
to irregular, tremulous, and often ludicrous mo- 
tions, on account of which the disease has been 
called " Insanity of the Muscles." 

The disease may develop suddenly, particularly 
when it results from injuries to the head, or 
elsewhere, but it generally comes on gradually. 
The first thing observable, which indicates the 
approach of the disease, is that there are awk- 
ward, uneasy movements, which the child can- 
not control, and these movements are seen to be 
confined to one side, generally to the arm. In 
a few days the trouble extends, and involves the 
legs, and they present the same irregularity of 



CHOREA, OR ST. VITUS DA:N T CE. 207 

motion, so that the child in attempting to walk, 
finds that it has not full control of its limbs, and 
falls. Now, it may be, that the muscles of the 
face have become involved, and the strange 
movements of the features begin, the child 
making peculiar faces, and absurd grimaces. 
The difficulty may now extend, and the whole 
body be affected at once, so that the legs, arms 
and features, are sometimes in almost constant 
motion. Anything that excites or embarrasses 
the patient, increases the difficulty, while if his 
attention is diverted, and fixed upon any object, 
the muscular movements are lessened, and dur- 
ing sleep the muscular movements usually cease, 
though there are cases where they do not. 

Frequently the disease is of a mild form, and 
inability to hold anything in the hand steadily, 
to keep the arms from twitching, slight distortion 
.of the muscles of the face, and ah occasional 
spasmodic movement of the head is all the trouble 
noticeable. In cases more severe, both sides of 
the body are usually affected, when the child is 
unable to seize any object, or if it succeeds in 
grnsping it, soon lets it drop, being wholly un- 
able to hold ifc 

The gait of the patient is very unsteady, and 
awkward, and in attempting to walk, the child 



208 CHOREA, OR ST. VITUS DANCE. 

is very apt to fall at any moment. The face is 
constantly out of shape, and if the patient 
attempts to show its tongue, it does so in a 
hurried, imperfect manner, with much difficulty ; 
the speech is stammering and almost unintelli- 
ble, and even swallowing becomes difficult. In 
the severest cases, the intellect of the child is 
impaired, and it presents an idiotic appearance. 
In some instances the child presents a pitiable, 
and distressing appearance ; the following is one 
which Dr. West mentions in his book on children's 
diseases. Speaking of a little girl he saw in the 
Children's Hospital in Paris, he says : " All the 
muscles of the body were affected ; her spine 
was often bent backward to an extreme degree, 
and her movements were so violent, and inces- 
sant, that it was necessary to place a board 
three feet high around her bed, to keep her 
from throwing herself over its edge, and by the 
violent grating of her teeth, she had forced 
almost all her teeth from their sockets." 

It has been noticed that there is more or less 
irresfularitv of the heart's action during; this clis- 
ease, probably owing to the fact that the mus- 
cles of the heart, in common with the general 
muscular system, are affected, and in acting 
spasmodically, greatly interfere with the circu- 



CHOREA, OR ST. VITUS DAKCE. 209 

lation. Like most all convulsive, spasmodic af- 
fections, St. Vitus dance is thought to be due to 
some irritation of the spinal cord, or other nerve 
centers, and there are good proofs that such is 
the real exciting cause. 

The disease may prove fatal, though it is very 
rarely the case. It is generally slow in devel- 
opment, and in disappearing, lasting for one 
month, and it may be several. One writer 
speaks of one hundred and seventeen cases, 
whose average duration was sixty-nine days. 

The treatment of this disease must depend in 
a great degree upon the general condition of the 
patient, and the severity of the disease. There 
is usually a tendency to torpidity of the bowels, 
therefore medicines to act moderately on the 
bowels will be required. The subjects of this 
disease are generally weak, pale, bloodless, in 
appearance, and require tonics. The various 
preparations of iron, and zinc, have been much 
used, and with more or less success in many 
cases. The carbonate of iron is a favorite prep- 
aration with some, and may be given in one or 
two grain doses, three times daily, to a child 
seven years old. Sulphate and valerianate of 
zinc in small doses, is useful in some cases. Dr. 
Flint of New York, speaks highly of mix vomica 

18* 



210 CHOREA, OR ST. VITUS DANCE. 

and strychnia, especially in those cases where 
there is a great lack of muscular power. Fow- 
ler's solution, which is an arsenical preparation, 
is also a useful remedy, but it should be given 
with care, and its effects watched closely. To 
children from five to ten years of age, it may be 
given in closes of one or two drops three times 
daily, in a little w T ater, occasionally omitting it 
for two or three days at a time. The oxide of 
zinc, tincture of Indian hemp, assafcetida and 
camphor, are all valuable remedies for use in 
this disease. 

Cold shower bath, particularly to the spine, 
with friction afterwards, is recommended, as well 
as the warm sulphur bath, and the following 
method of Dr. West's for preparing it, will be 
found convenient : Add six and one-half ounces 
of sulphuret of potassium to a common bath, 
heated pretty warm, or to 90 degrees Fahrenheit, 
and let the patient remain in the bath an hour 
daily. Belladonna given in small doses every 
few hours, is valuable in some cases, and when 
used should be continued for several days. Dr. 
Douglas, Vice-President of the Medico Surgical 
Society of Edinburg, speaks highly of Indian 
hemp as a remedy. Dr. Fraser of Edinburg, 
and Dr. Ashdown, highly recommend calabar 



CHOREA, OR ST. VITUS DANCE. 211 

bean in the treatment of this disease. In some 
cases electricity is useful, while in others, gym- 
nastic exercises have had a good effect, by divert- 
ing the mind from the diseased condition, and 
regulating the muscular movements by well 
directed and systematic efforts. The diet of the 
patient should be easily digestible, yet nutritious ; 
the patient should be allowed exercise in the 
open air, and should be kept free as possible 
from any excitement, or anything calling forth 
much physical or mental exercise. The general 
tendency of the disease is to recovery if left to 
itself, but it usually lasts for weeks or months 
unless cut short by remedial measures. The 
treatment that suits one individual case, may be 
ill-adapted to another, therefore care and dis- 
cretion is required in directing the treatment. 



INFANTILE PARALYSIS. 



Paralysis is generally considered a very seri- 
ous disease, in older people, and it is in fact fre- 
quently fatal, while in children it is not usually 
attended with serious results, the trouble as a 
rule proving to be but temporary. Paralysis 
occasionally manifests itself soon after birth, 
and seems to depend upon some original bodily 
defect, in which case the child seems to have 
but little control over the extremities on one 
side of the body, and the limbs on that side are 
smaller and poorly nourished. In these cases 
treatment can be of little service, beyond mechan- 
ical appliances to properly support the limbs, 
and guard against deformities. 

Infantile paralysis can often be traced in its 
commencement to some disturbance, or conges- 
tion of the brain, which was attended by a single 
convulsion perhaps, or by a sense of heaviness 



INFAXTILE PAEALYSIS. 213 

of the head which lasted for a short period. It 
is always best to examine a child after any con- 
vulsive attack, to see if it is followed by any 
signs of paralysis or difficulty in moving the 
limbs. 

Again, paralysis may come on independent of 
any disease of the brain or nerve centers, and 
may be owing to the irritation of teething; to 
long continued inactivity of the bowels ; or it 
may follow a febrile attack, and not infrequently 
results from general debility and prostration of 
the system. The affection seems to be most 
common from two to eight years of age, the 
period of teething, and there is no doubt that 
this process gives rise to the irritation of the 
nervous system, which results in paralysis. 

The disease may attack one arm or leg, or 
may attack both together, and it may affect the 
whole of one side of the body at once. Some- 
times it attacks one side of the head, face and 
neck, and occasionally the lower half of the body. 

If the paralysis comes on suddenly, involving 
both limbs on one side at once, and there is no 
evidence of brain s}nnptoms, it is pretty safe to 
say that there is no organic disease of the brain, 
while on the other hand, if the disease comes on 
gradually, and only one limb is affected, if there 



214 INFANTILE PARALYSIS. 

is involuntary twitching of the muscles, with 
contractions of the fingers and toes, it is prob- 
able that serious organic disease of the brain or 
spinal cord exists. 

In the majority of cases of simple paralysis, 
the palsy comes on after a single fit, but if it 
depends upon some disturbance of the brain, it 
usually manifests itself after several convulsive 
seizures, during each of which, the limb that is 
afterwards paralyzed, is in a peculiar and fre- 
quent motion. 

If paralysis is lasting in a child, it creates 
greater deformity than in a grown person ; the 
growth of the limbs is arrested, the muscles of 
the limbs waste away, and the limb involved is 
shorter than the sound one. The muscles act 
involuntarily, and the limbs are often drawn out 
of shape, so that an operation is required to 
remedy the deformity afterwards. To guard 
against the liability of these deformities result- 
ing from paralysis, children should be constantly 
and carefully watched, until entire recovery has 
taken place. Soon as palsy is discovered in chil- 
dren, its cause should be sought for at once, and 
removed if possible, and the treatment must 
depend largely upon the cause of the trouble. 
Nux vomica is highly spoken of by Dr. West, as 



INFANTILE PAEALYSIS. 215 

an internal remedy, given in doses of one-eighth 
of a grain of the alcoholic extract, three times 
daily, to a child four years of age. The prepa- 
rations of nux vomica and strychnia, operate to 
increase the power and tonicity, or strength of 
the paralyzed muscles. If the legs be affected, 
the child should have its limbs well rubbed 
three or four times daily, the palsied limbs 
should be moved frequently with the hands ; the 
child should be supported by the parents, and 
efforts be made to make the patient move or 
swing the limbs to and fro, the passive motion 
to be kept up in this way until the use of the 
muscles is regained. Splints are often required 
for a long time after the patient begins to use 
the limb, in order to guard against deformity, as 
the muscles being weak will yield readily in the 
direction of the greatest weight, or pressure. 

The digestive organs should be kept in a 
healthy condition, and regular in their action. 
The cold shower bath to the limb or part affected, 
followed by thorough friction, is of great use to 
restore the warmth of the part, and to regulate 
the circulation therein. Electricity proves of 
good service in many cases, while in others it is 
of no account whatever. The author has in 
mind one case of a little boy about three years 



216 INFANTILE PARALYSIS. 

of age, who had both legs completely palsied, 
who speedily recovered, under the following 
treatment : The upper portion of the spine was 
painted with croton oil, until the skin was thickly 
covered with small pustules or blisters, and the 
child was ordered to take internally small doses 
of tincture of mix vomica and iodide of potassium 
three or four times daily ; his limbs were bathed 
in strong mustard water, once or twice daily, 
and thoroughly rubbed, and a good generous 
diet was allowed. The child was able to walk 
nearly as well as ever, in four weeks from the 
commencement of the treatment. 

Dr. J. R. Reynolds, Physician to University 
College Hospital, in speaking of the use of elec- 
tricity in infantile paralysis, says : " The most 
efficacious application is that of the interrupted 
battery current, and a curious fact is commonly 
elicited by its continued use. You find, for 
example, a group of wasted, palsied muscles, 
inactive to faradization, but responding readily 
to galvanism. You apply galvanism on several 
occasions, and observe that gradually some vol- 
untary power returns, and with this a diminution 
of response to the agent you are employing. 
The same muscles were unaffected by faradiza- 
tion at first, but now as their voluntary power 



INFANTILE PAKALYSIS. 217 

returns, and their contractility to the battery- 
current diminishes, they act readily when the 
induced current is applied. When, after six or 
eight applications of both faradic and battery 
electricity, there has been no appearance of 
electric irritability, I have seen no good result 
from its continued use." 

It appears from this that it is important to 
change from frictional to galvanic electricity, 
and vice versa. 

There are many children suffering from palsied 
and deformed limbs, past hope, that might have 
been remedied, had proper attention been paid 
to moving the limbs often, with the help of an 
assistant, rubbing the limbs frequently, and 
thoroughly, and exercising the muscles of the 
diseased limbs in every possible way, and by 
giving the limbs in this weak condition, proper 
support, by means of mechanical appliances. 

While there are cases hopelessly incurable, 
owing to some early malformation of the body, 
or congenital disease, as organic disease of the 
brain and spinal cord, it is true that the major- 
ity of children with paralysis recover the sound- 
ness and use of their limbs. 

19 



NIGHT TERRORS. 



This is an affection dependent upon some irri- 
tation of the brain, caused frequently by some 
disturbance of the digestive organs. A child 
subject to them, may go to bed seemingly per- 
fectly well, but two or three hours after it has 
been asleep, or during the night, it awakes sud- 
denly in great alarm, and utters a loud cry, 
while its attention seems absorbed by some 
fearful dream, and its attention is fixed upon 
some imaginary object of its alarm. At first 
the child does not recognize its friends, but 
after being quieted and soothed, it weeps, sobs, 
and gradually falls asleep. The attack seldom 
returns the same night, and may not for two or 
three nights afterward. 

Children subject to this trouble should not be 
frightened by sleeping alone in a room without 
a light, for it is under these circumstances that 



NIGHT TERRORS. 219 

they are most troubled with visions of their 
imaginary foes. 

In treating a patient subject to night terrors, 
the constipation that usually exists, should be 
relieved by mild laxatives, such as confection of 
senna, or fluid extract of rhubarb and senna, 
and the digestive organs should be kept in a 
healthy condition. A tonic and laxative mix- 
ture recommended by Dr. Tanner, after the fol- 
lowing formula, will be found useful : Bi-tartrate 
of potash, two drachms ; aromatic spirits of am- 
monia, twenty minims; compound tincture of 
cardamons, one drachm; extract of liquorice, 
one scruple ; compound decoction of aloes, two 
ounces ; mix and give one teaspooniul every 
hour or two. 



WASTING DISEASES OF CHILDREN. 



It has been almost the universal custom, as 
Dr. Eustace Smith of London says, to apply the 
vague terms of tabes mesenterica, marasmus and 
atrophy, to the slow, wasting, fatal disorders of 
children, the origin, or real nature of the disease 
not being clearly understood or expressed. It is 
safe to say that in all cases of wasting, loss of flesh 
in infantile life, that there is some change, or 
defect, in the nutritive processes, whereby the 
growth and health of the body is maintained. 
The waste of the body is unnatural, or far greater 
than the supply of new material. 

It is true that every deviation from health, 
will to a greater or less degree impair the nutri- 
tion of the body, as is the case in diarrhea, and 
inflammations in children, but there are cases 
where the primary disease, the disease per se, 
seems to be that of imperfect assimilation and 



WASTING DISEASES OF CHILDREN. 221 

nutrition. Those cases of slow impairment of 
nutrition, with gradual loss of flesh, where the 
wasting cannot be traced to any acute disease, 
are the ones to be specially considered under 
this head. 

The cause of this arrest, or impairment of the 
process of nutrition, is often the use of improper 
food, the child almost starving from inability to 
digest and assimilate the food with which it is 
supplied. There may be some unhealthy con- 
dition of the digestive organs themselves, or 
some constitutional taint, as the existence of 
tuberculosis, or the inheritance of syphilitic 
poison in the blood, which interferes with the 
proper nourishment of the tissues. 

Whenever wasting of the body is manifest 
in children, not associated with any acute disease, 
it is plainly evident that the vital processes which 
sustain the strength and growth of the body, are 
failing, and therefore it is highly important to 
detect the first evidences or symptoms of defec- 
tive nutrition. Wasting is not always one of the 
first signs, and it may be absent if the interfer- 
ence with nutrition is not excessive. A child 
may be plump, and appear to be in perfect 
health, and at the same time be suffering from 
the slow, but sure approach of rickets, and if 

19* 



222 WASTING DISEASES OF CHILDREN. 

the cause operating to produce the disease be 
inherited, it will develop itself unmistakably, in 
a short time. 

It is true that acute disease is often the start- 
ing point of these wasting diseases of the body ; 
either by kindling up some peculiar constitu- 
tional tendencies to disease, by leaving behind 
some chronic derangement of the digestive or- 
gans, or by some mysterious influence over 
nerve power. Thus, measles often excite mani- 
festations of some latent, or hitherto hidden 
tendency to tubercle or consumption. Scarlet 
fever and measles, as is well known, are apt to 
be followed by obstinate diarrhea, and dipthe- 
ria is frequently followed by loss of nervous 
power, and paralysis. Therefore, in all diseases, 
especially in children, there are two sources of 
danger to guard against, viz., those immediate, 
and those that succeed, or are remote. 

Acute diseases are generally marked by prom- 
inent symptoms, which call for and secure prompt 
attention, but the contrary is true in the slow, 
insidious chronic diseases, the progress of which 
is measured by the gradual undermining of the 
constitution, thereby lessening nutrition, and 
causing emaciation. 

In fact, this class of disorders are apt to be 



WASTIXG DISEASES OF CHILDREN. 223 

overlooked, or disregarded, until the wasting of 
the body is so rapid or so noticeable as to cause 
alarm in itself. Of course the infant cannot 
communicate its feelings by speech, therefore 
the eye must be educated to gather from the ex- 
pressions and gestures of the infant, the desired 
information, for by these we can certainly detect 
the presence of pain, and readily locate it. Thus, 
pain in the head is attended by contraction of 
the eye brows ; pain in the chest, by sharpness 
or contraction of the nostrils ; and pain in the 
belly, by a drawing of the upper lip, and of the 
lower extremities. The color of the face is to 
be carefully noticed. Blueness of the lips and 
eyes show that the blood is imperfectly aerated, 
and its circulation interfered with. A waxy, 
yellowish color is said to indicate inherited 
syphilitic disease, and there is apt to be an 
earthy, sallow hue of skin, in chronic disease of 
the intestinal canal. 

Exhaustion is indicated by coldness and pale- 
ness of the face ; by blueness of the eye-balls 
and mouth, with half closure of the eyelids and 
mouth, and by depression of the fontanelles or 
openings between the bones of the skull. The 
character of the breathing is another important 
symptom. For instance, if rapid, with much 



224 WASTING DISEASES OF CHILDREN. 

movement of the nostrils, probably bronchitis 
or lung fever exists. Unequal movements of 
the two sides of the chest, indicate serious de- 
rangement of one side. 

The cry of the child is varied, and itself is an 
important symptom of disease. When it is short, 
sharp, and shrill, or sudden, it shows that the 
brain is the seat of the disease. When there is 
pain in the bowels, the cry is generally pro- 
longed ; in inherited syphilitic disease, it is 
hoarse, and high pitched ; in disease of the 
throat, it is hoarse or whispering. In inflamma- 
tion of the lungs, and severe rickets, children 
do not cry much on account of the pain produced 
in so doing. 

Weakly children often have large bellies, 
w T hich excites alarm in the minds of most parents, 
and it may be owing to various disorders or 
diseases, but most usually is caused by the col- 
lection of large quantities of gas. This gaseous 
accumulation is frequently a source of great 
annoyance during the first two or three months 
of infantile life. 

It is generally the case that children with 
tubercular disease of the bowels, or consumption 
of the bowels, as it is sometimes called, have 
swollen or enlarged bellies, but this unnat- 



WASTING DISEASES OF CHILDKEN. 225 

ural largeness may be caused by enlargement 
of the liver, spleen, or various organs within 
the abdomen. 

In the treatment of chronic wasting in a young 
child, the first object should be, to remove any 
derangement of the stomach and bowels that 
may exist, and a strict regulation of the bowels 
is demanded. Frequently the whole trouble can 
be traced to improper feeding, therefore the diet 
should be carefully attended to, after which some 
special treatment may be resorted to, if required. 
External applications are useful in restoring 
healthy action of the skin, and for this purpose 
friction, counter irritation, and hot or cold baths 
may be used. Friction may be produced with 
the hand alone, with stimulating liniments, or 
with either olive or camphorated oil. By these 
means the circulation of the blood is improved, 
and the action of the skin increased, and made 
more healthy. 

The feebleness of the constitution in infancy 
is shown by coldness of the extremities, and in 
chronic diseases attended with cold feet, prompt 
beneficial results will be noticed after the appli- 
cation of warmth. The infant will generally 
cease crying, pain will cease, and sleep result. 



226 WASTING DISEASES OF CHILDKEN. 

Friction of the whole body should be resorted to, 
unless there is tenderness, which is usually the 
case in children suffering from rickets, or spinal 
difficulties. Rubbing cod-liver or sweet oil into 
the skin is highly recommended by the highest 
authorities, as a means of introducing nourish- 
ment into the system in chronic disorders, espe- 
cially where there is great irritability of the stom- 
ach and bowels, and certainly some remarkable 
results have followed this practice. These oily 
applications have another purpose than that of 
introducing or affording nutriment. When the 
oil, slightly warmed, is rubbed over the whole 
body with a sponge, and the child is wrapped in 
flannel, and placed in bed, one of the first effects 
noticed is a general perspiration, while at the 
same time the irritability of the nervous system 
is allayed, and the infant rests quietly and 
soundly. Another effect noticed is an increase 
of all the secretions; the urine is more abun- 
dant, the liver is. more active, and the bowels are 
more natural in their action. A warm bath 
before the application of the oil, increases its 
usefulness by promoting the healthy action of 
the skin, and the absorption of the oils. Warm 
friction baths in which mustard has been put 



WASTING DISEASES OF CHILDREN. 227 

in sufficient quantities to produce slight irrita- 
tion and redness of the skin, are beneficial. 
Cold baths should never be used for weakly 
children, as the shock to the nervous system 
would be more injurious than the bath would be 
beneficial. As to internal remedies, they will be 
spoken of more fully when we consider the treat- 
ment of the several wasting diseases separately. 
Tonics are called for soon as the digestive organs 
are brought into a healthy state. Cod-liver oil 
is a nutritive tonic much used, but it needs to be 
given in small quantities to children, for if given 
in larger quantities than can be digested it will 
be seen to pass off with the stools unchanged. 
For a child under two years of age, ten or fifteen 
drops is enough for a dose to begin with, repeated 
two or three times a day, and if well borne, the 
dose can be gradually increased from day to day. 
If the fontanelles, or openings between the 
bones of the skull, are depressed or sunken, 
stimulants are required, and pale brandy may be 
given in ten or fifteen drop doses, and repeated 
as often, as the case demands. The dose is al- 
ways to be increased in proportion to the age of 
the child. The following diseases which give 
rise to wasting and innutrition of the body will 



228 WASTING DISEASES OF CHILDREN. 

be treated of separately, viz. : simple wasting 
from insufficient nourishment, chronic diarrhea, 
chronic vomiting, chronic tuberculosis or con- 
sumption, and disease of the glands. 



SIMPLE ATROPHY FROM INSUFFICIENT 
NOURISHMENT. 



This is the most common form of wasting 
disease in children, especially in the larger cities, 
and thousands of children die annually for the 
simple reason that they are persistently fed 
upon food they cannot digest, and so long as the 
children of the poor remain uninstructed regard- 
ing the duties which they are to fulfill in after 
life, so long will this one evil continue to increase 
the table of infantile mortality. 

The causes of insufficient nourishment are 
various. The supply of food may be inadequate 
to afford the necessary nutriment ; which is often 
the case where the infant is nourished entirely at 
the breast, and the mother's milk is poor and 
watery ; or in those cases where the breast has 
afforded the only nutriment long after the child 
should have been fed with other food. When 
the mother is weak, pale, thin in flesh, her milk 

20 



230 SIMPLE ATROPHY. 

is thereby rendered poor, and affords but little 
real nourishment to the infant. 

Women of strong constitution, in good flesh 
and strength, do not always give milk of a 
healthy quality, the sugar and casein frequently 
being deficient in quantity. The best test of 
the goodness of the milk is well said to be de- 
rived from observing the child. It should be 
watched while at the breast, and if it sucks vig- 
orously, ending its meal with the milk running 
over its lips, and requires to nurse but a few 
times daily, it may be inferred that the milk is 
sufficient in quantity, and of good quality. 
Besides those cases where the quantity of food 
is at fault, there is another class of cases where 
nutrition is equally unsatisfactory, although the 
quantity of food is liberal enough. These cases 
occur where weaning is premature, or where the 
child has been brought up by hand, and the kind 
of food selected to replace the natural food, is 
improperly chosen, proving too much for the 
limited digestive powers of the infant, so that it 
is not converted into nutritive material for assim- 
ilation. It is therefore seen that a child is not 
nourished by the quantity of food introduced 
into the stomach, but only by the amount cf 
food it can digest and assimilate. A child may 



SIMPLE ATROPHY. 231 

take large quantities of food into its stomach, 
and from weakness of the organs of digestion, 
or from the indigestible nature of the food, 
receive no nourishment from it whatever, but 
on the contrary, it may cause great irritation 
and pain, with more or less fever, which tends 
to still farther reduce the child. 

The natural tendency of the mother is to over 
feed the infant, mistaking every cry for the cry 
of hunger, and so as the fretfulness of the in- 
fant increases with the increase of pain, the food 
is made more nourishing, or more frequently 
given, until a violent attack of vomiting, or con- 
vulsions, warns the parent of the excess, and 
that it is time to stop. Cases of constant and 
steady loss of flesh are often due to this cause 
alone, especially in infants brought up by hand. 

The children of the poor are often fed with 
starchy food, which affords but little nourish- 
ment, and in consequence thereof they rapidly 
dwindle and die, or if of a natural robust con- 
stitution, linger for a long time weak, rickety, 
and are finally carried off with a bowel com- 
plaint, or some secondary affection. For perfect 
nutrition, four classes of food are required, viz. : 
albuminates, or those containing albumen, fatty 
substances, carbo-hydrates, or those containing 



232 SIMPLE ATROPHY. 

carbon and hydrogen, and salts. These are all 
found in the most digestible forms, and perfect 
proportions for the young child, in the casein, 
butter, sugar and salts of the human milk, pro- 
vided always that the quality of the milk is 
what it should be in the normal standard. The 
casein supplies the waste of the muscles, brain 
and nerves, and by its oxidation when it has 
formed a part of these tissues, contributes to 
animal heat, thereby keeping up the temperature 
of the body. The butter, or fatty substances, 
are necessary to the formation of muscular and 
nerve tissue, and also aids by its oxidation or 
combustion in the production of heat. The 
sugar is principally heat giving, while the salts 
form the necessary constituents of all tissues. 

For perfect nutrition it is necessary that 
change of tissue should be rapid, and this is es- 
pecially true in infants, where growth and de- 
velopment are so rapid. This change is pro- 
duced by the oxidation, or destruction of old 
material, which is removed, and gradually re- 
placed by new; so for rapid change of tissue it 
is important that no impediment should exist to 
the free oxidation thereof. 

Now the starches, and sugars into which the 
starches are converted by the process of diges- 



SIMPLE ATROPHY. 233 

tion, have a greater affinity for oxygen than the 
albuminates, so that they tend to appropriate 
the oxygen which is required for the removal of 
waste material, and thus prevent the proper 
changes taking place. For this reason alone, 
without any reference to their indigestible prop- 
erties, they form a very improper diet for chil- 
dren. 

Infants that are fed entirely on cow's milk are 
not entirely free from clanger, for the specific 
gravity of cow's milk is higher than that of 
human milk, and it contains a larger quantity of 
solid matter, owing to an increase of the amount 
of casein. The proportion of sugar is less than 
in human milk, therefore in substituting it for 
the natural food of the infant, these differences 
should be remedied by diluting the milk with 
water, and the addition of sugar. 

There is another difference between human 
and cow's milk, which it is important should be 
noticed. On the addition of rennet, human 
milk coagulates into loose clots, or flakes, while 
cow's milk coagulates into heavy, compact lumps, 
and the same result takes place in the stomach 
of the infant. It will readily be seen that there 
is a wide difference between the digestibility of 
these two products, one being readily assimilated, 

20* 



234 SIMPLE ATROPHY. 

without any undue demands upon the digestive 
organs of the infant, while the other frequently 
tasks the digestive powers to their utmost ; and 
unless a small quantity is taken, it Avill often 
undergo fermentation, giving rise to flatulence, 
colic, and diarrhea. 

Some children thrive upon this kind of diet, 
while others, and by far the largest part, do not, 
for it is impossible for them to digest and assim- 
ilate this mass of curd, and unless it is rejected 
by vomiting, it passes off through the bowels 
unchanged; their wants are not supplied, and 
they starve for lack of nourishment, although 
swallowing every day a quantity of milk, which 
would afford an ample support for a much 
stronger and healthier child. Children suffering 
in this way from improper diet, are irritable and 
restless, crying day and night, at one time from 
pain in the bowels — at another from hunger, 
which their diet has failed to relieve. In all 
cases where the food of the infant is said by the 
nurses to be insufficient, the stools should be 
carefully examined, and if they are found to 
consist of pale, hard, round lumps, exhibiting in 
their interior the cheesy appearance so charac- 
teristic of a mess of curd, we may safely say 
that not too little but too mack has been given. 



SIMPLE ATROPHY. 235 

There are often constant attacks of vomiting and 
diarrhea resulting from this surplus of food, which 
add greatly to the debility of the infant, and 
the impairment of the digestive powers; The 
symptoms of simple wasting may be divided into 
two classes, according to the nature and quantity 
of food taken, to wit : food suitable but insuf- 
ficient ; food unsuitable. In the first of these 
two classes there are no very prominent symp- 
toms, especially early in the disease ; the infant 
gradually loses its plumpness, its fat slowly dis- 
appears, and the muscles get soft and flaccid. 
The child does not seem to grow, its skin is 
moist, it perspires freely, the face and lips are 
pale and thin ; is feverish on account of hunger, 
takes the breast ravenously at first, and if the 
secretion of milk is scanty, stops at intervals, 
and cries as if vexed at its inability to obtain 
food sufficient to supply its wants. At night the 
child is irritable and restless, but in the day-time 
is drowsy, sleeping a greater part of the time. 

The bowels are usually confined, and the 
stools solid, and in this class of cases, nutrition 
is deficient on account of the inferior quality, 
and small quantity of the mother's milk, noth- 
ing being added to supply the deficiency. When 
the required nourishment is given, the wasting 



236 SIMPLE ATPOPHY. 

or loss of flesh ceases, the child is no longer fret- 
ful, and regains flesh and strength rapidly. 

In the second class of cases, where the food is 
bad in quality, we find the symptoms of imper- 
fect nutrition, combined with other symptoms 
produced by the irritation of the digestive 
organs, which the indigestible food gives rise to. 
The child is dull, languid, flesh becomes flabby 
and it begins to waste ; the skin is moist at first, 
though it is apt to become dry, except about the 
head ; the face and body generally are pale, and 
sometimes the complexion turns yellowish, as- 
suming a jaundiced appearance, which remains 
for hours, days, or weeks, as the case may be. 
The tongue is clear and moist, and remains so 
unless there are symptoms of acute digestive 
disturbance. The bowels are irregular in their 
action, generally constipated, sometimes, how- 
ever, they are open three or four times daily, 
the stools being green, liquid, slimy, and very 
offensive, and in either case the food which the 
child has taken passes through the bowels with- 
out being digested. Flatulence, or wind colic, 
is a source of great annoyance to the infant, 
often causing frequent paroxysms of pain, in 
which the face becomes pale, the upper lip livid, 
and the belly tense ; the child utters piercing 



SIMPLE ATEOPHT. 237 

cries, and draws its legs suddenly upon the belly. 
During sleep frequent startings and moanings, 
elevation of the corners of the mouth, and con- 
traction of the eye-brows, show that the child 
is suffering from abdominal pain. The pain and 
uneasiness from which these children suffer, and 
which is constantly renewed at every additional 
meal, makes them so noisy as to be almost intol- 
erable, and well may the mothers say that " they 
wear one's life out." At this time they are apt 
to be feverish, and are seized with fits of scream- 
ing which they persist in until too much fatigued 
for further action. 

Notwithstanding all this disturbance, the ap- 
petite of the child is ravenous, owing to the 
acidity, and flatulent condition of the stomach. 
Eruptions upon the skin are very common in 
connection with deranged digestion of the infant. 
Attacks of nettle-rash, and the eruptions known 
as red and white gum are frequent, appearing 
on the face, neck, and arms, occasionally over 
the whole body. Thrush, or disease of the 
mouth, is another consequence of unsuitable 
diet, and is most prevalent in warm weather. 
The mucous membrane of the mouth becomes 
red, the little pearly white eruptions appear 
upon the inflamed surface, run together and form 



238 SIMPLE ATROPHY. 

patches, sometimes extending so as to cover the 
whole of the inside of the mouth. There is 
usually little fever, with more or less thirst, and 
sometimes a thin, watery diarrhea. Another 
symptom of the irritation excited by improper 
food is that trouble knows as inward fits. The 
phenomena which attend this condition of things 
are blueness or lividity of the upper lip, which 
is more or less everted, and inclined to twitch. 
A slight squint or rotation of the eye, with con- 
traction of the fingers, and turning the thumbs 
inward. These symptoms should never be 
allowed to pass unnoticed, as they are the almost 
sure indication of convulsions. When there 
has been a great accumulation of food in the 
stomach of an indigestible nature, the symptoms 
are often quite severe, the skin gets hot, face 
flushed, and violent vomitings of sour smelling 
food take place, with great straining. At the 
same time the bowels are loose, and large, dark 
green or putty-like stools are passed with great 
effort. The belly is full, hard, and irregular to 
the feel. The child refuses all food, is thirsty, 
but usually vomits the fluid as soon as taken. 
Sometimes a convulsion ushers in the attack, 
and frequently the convulsions recur so often 
that death follows from exhaustion. 



SIMPLE ATEOPHY. 239 

When the attack subsides the infant goes on 
wasting in flesh and strength as before, unless 
some new measures are adopted for its general 
improvement. The attacks coming on one 
after the other leave the infant weaker, its face 
wrinkled and old looking ; its eyes dull and 
hazy ; it expression languid and weary, and as 
the debility increases, the griping pains to which 
it is subject, do not excite a cry, but simply a 
pitiful moan, or it may be a simple contraction 
or movement of the features, without any sound 
from its lips. Any acute disease attacking a 
child in this condition, readily proves fatal, for 
the reason that all power of resistance has been 
starved out of it. 

The least cold or catarrh leads on to pneumo- 
nia, or bronchitis ; a chill is followed by a pro- 
fuse diarrhea, which now and then assumes a 
chronic form, and terminates the existence of 
the sufferer. 

The treatment of simple wasting from want 
of nourishment, consists mainly in so selecting 
the diet of the infant with proper regard for 
age, that it may be able to digest, and there- 
fore be nourished by all food taken. The 
weaker the child the nearer does its condition 
resemble that of the new-born infant in its power 



240 SIMPLE ATROPHY. 

of assimilating different articles of food, and 
therefore the earlier in the scale must we look 
for nutriment suited to its wants. 

In properly considering this subject of wast- 
ing and its treatment in the early life of the 
infant, it is perhaps necessary to repeat some 
things that have been alluded to in the chapter 
on nursing, as the rules there laid down need to 
be enforced here. 

The child should be nursed by its mother, or 
at least mothers ought to try to do it, partly 
for their own sakes, as it causes uterine con- 
tractions and prevents diseases of the breast ; 
partly for the child's sake, as the mother's milk 
is as a rule, better adapted to the child than 
that of a stranger. 

Where the mother is unable to nurse the 
child a wet nurse should be substituted, in the 
choosing of which great care should be exercised, 
and two points especially considered, to wit : the 
state of her health and age of her milk. With 
regard to her health she should be examined for 
signs of consumption, scrofula and syphilis ; her 
breasts and milk should be examined, and her 
child should be looked at to see if it is well 
nourished and healthy in appearance, for if it is 
healthy and robust, it is the best evidence that 



SIMPLE ATROPHY. 241 

her milk is not faulty. The diet of the mother 
or nurse should be liberal, and a certain amount 
of wine, ale or porter may be allowed, and fresh 
vegetables and fruits may be included in her 
meals. 

When the child gets to be six or eight months 
old its meals need not be so frequent, and the 
nurse will be able to tell when the child cries 
from hunger, and can meet the requirements of 
the case as she sees the necessity. If the babe 
rouses itself and seems pleased, at the same time 
clutching at the breast, you may know it is hun- 
gry, but if it be indifferent and remains quiet, it 
is safe to say it has no appetite, and if it cries, 
is fretful, throws its limbs about, it has no doubt 
got pain in the stomach or bowels, so that more 
milk taken would simply add to its misery. Up 
to six months of age the child may derive its 
entire nourishment from the breast, provided it 
does well, grows, and gives evidence of good 
nourishment. When children are brought up on 
the bottle, cow's milk is used, which needs dilu- 
tion and additions to render it proper to use. 
For the first six weeks the milk may be diluted 
with an equal part of lime w^ater, and a tea- 
spoonful of sugar should be added to every six 
ounces of the mixture. Some physicians advise 

21 



242 SIMPLE ATEOPIIY. 

the addition of two teaspoonfuls of cream to 
half a pint of the diluted milk. After six weeks, 
the proportion of lime water may be reduced to 
one-third, and after four or five months, cow's 
milk may be given clear. The child must be 
fed at regular intervals, from three to four ounces 
being given every two or three hours during the 
first six weeks. The milk should be put into a 
feeding bottle, and the child be allowed to suck 
till it is gone, but never should it be allowed to 
suck an empty bottle, as it swallows air in so 
doing, which becomes a source of trouble to it 
afterwards. The bottle should be thoroughly 
cleansed after each time using, and then be placed 
in a basin of cold water until wanted again. 

When the child is six months old, something 
beside milk may be given, and among the many 
simple articles of diet spoken of is one advised 
by many eminent physicians, prepared for use as 
follows : a pound of wheat flour tied up tightly 
in a bag, is placed in a sauce-pan of boiling 
water, and is allowed to boil continually for ten 
hours. At the end of this time, after removing 
the cloth, a yellowish white ball is seen, feeling 
soft and elastic to the touch, like India rubber. 
When cold, the soft outer coat is cut away, and 
the inside, which is hard, is reduced to a fine 



SIMPLE ATROPHY. 243 

powder. For a child six months old, two tea- 
spoonfuls of this may be added to its milk every 
day. It is to be rubbed up and gradually dis- 
solved in boiling milk, and so made ready for 
use. Should this flour not agree with the infant, 
there are several preparations of infant's food, 
which come already prepared, which may be 
used instead. After the eighth month a little 
oyster, mutton, chicken or beef broth, may be 
given as an extra meal, but not in addition to 
their ordinary meal. 

Some children in using cow's milk are con- 
stantly vomiting up curds, even if lime water 
has been added, and in such cases, one tea- 
spoonful of isinglass, or gelatine, dissolved in 
four ounces of milk and water, will prevent the 
running together of the curds. It is in such 
cases as these that Liebig's food for infants is so 
valuable, for this can be digested in most cases 
where no other food can be borne. 

The time of weaning is very important to con- 
sider. Too early weaning may be more or less 
dangerous, and too long continued nursing is 
a) 1 ended with much evil. In ordinary cases, 
where the child is healthy, twelve months should 
be allowed to pass before weaning takes place. 
To nurse the child longer would make too great 



244 SIMPLE ATROPHY. 

a demand upon the mother, and would be of no 
advantage to the child. ■ 

Human milk generally is the best food for 
infants, bat when it becomes so poor as to be no 
longer nutritious, it ceases to be food, but the 
child's stomach is filled with a fluid worse than 
useless, affording no nourishment itself, and 
destroying the appetite for other food. Although 
it is best to nurse a child one year, circumstances 
may arise which render it necessary to wean 
the child much sooner, among which the follow- 
ing may be mentioned. If the mother's health 
is suffering ; if from some cause, as pregnancy 
or acute disease, the mother's milk is rendered 
unwholesome ; if the child is not sufficiently 
nourished by the breast, and yet refuses to take 
other food ; or if the monthly courses come on; 
these all are good reasons for weaning. 

The time for weaning should be chosen when 
the child is free from any disorder, and it should 
not take place during the summer months, if it 
can be avoided. It is best to wean the child 
gradually, lessening the frequency of its meals 
for a week, when it may stop nursing altogether. 

When the child has become used to doing 
without breast milk, it may begin to take the 
food which is to form its ordinary diet. Pota- 



SIMPLE ATROPHY. 245 

toes thoroughly mashed, light puddings, soft 
boiled eggs, or a bone to suck may be allowed. 
No meat should be given until the sixteenth or 
eighteenth month, when a small quantity may 
be given once a day. In changing the diet of 
children it is well to watch its effects upon the 
digestive organs of the child, to see that no ill 
effects follow. 

It is highly important that perfect cleanliness 
should be maintained. The whole body should 
be well washed with warm water and soap every 
morning, and after each bath the skin should be 
rubbed with the hand, or flannel, until a healthy 
glow of the skin is excited. The napkins should 
be frequently changed, and the nates sponged 
with warm water, and thoroughly dried. The 
child should sleep alone on a cot, instead of 
with the mother or nurse. The nursery should 
be large, well ventilated, not too warm, and 
should face the south, where it is exposed to 
sunlight. ' The child should be taken out fre- 
quently in favorable weather, and should be 
dressed warm, so as to be well protected against 
cold and currents of air. Any and every de- 
rangement of the organs of digestion should be 
immediately attended to. Constipation, which 
is a common result of improper food, often con- 

21* 



246 SIMPLE ATROPHY. 

iinues after the diet has heen changed, and calls 
for remedial measures. In cases where the infant 
at the breast is troubled with constipation, the 
mother should occasionally take some saline 
aperient, as Seidlitz powder, Rochelle powder, 
or something of the sort, and should use more 
vegetables in her diet. Should this plan not 
relieve the child, a teaspoonful of castor oil, 
fluid extract of rhubarb and magnesia, or rhu- 
barb and senna may be given. Daily friction 
of the belly with the hand, and with some stim- 
ulating lotion is useful. Dr. Morrison recom- 
mends the following : Compound tincture of aloes 
one-half an ounce, compound soap liniment one- 
half an ounce ; to be mixed and applied to the 
belly every morning with thorough friction. 
For a child a year old, with constipation, Dr. 
Dunglison advises a drachm of Socotrine aloes 
to be dissolved in an ounce of simple syrup, and 
given in teaspoonful closes until the bowels are 
relieved. Injections of water, with either soap, 
salt or molasses, into the bowel, will often an- 
swer the purpose. At least a gill should be in- 
jected at once, and should be used about luke- 
warm. Should there be diarrhea, instead of 
constipation, with dark, offensive, slimy stools, a 
dose of powdered magnesia and rhubarb, five 



SIMPLE ATEOPHY. 247 

grains of each, may be given, and followed by 
this mixture : Laudanum twelve drops, castor 
oil one drachm, syrup of ginger half an ounce, 
mucilage gum acacia two ounces ; one teaspoon- 
ful is to be given three times daily. If there 
should be a sour smell to the breath, a few 
grains of prepared chalk may be given. 

The feet should always be kept warm, for cold 
feet alone will give rise to pain and uneasiness in 
the bowels of the infant. Sometimes the flatu- 
lence, or wind colic is severe, when the belly 
should be rubbed with some warm, stimulating 
liniment, and the following mixture be given: 
Infusion of rhubarb one ounce, syrup of ginger 
half an ounce, tincture of myrrh half a drachm, 
peppermint water three ounces ; give in doses of 
two teaspoonfuls three or four times daily. If 
sickness attends the colic, one teaspoonful of the 
syrup or wine of ipecac may be given to relieve 
the stomach, after which this mixture may be 
given : Subnitrate of bismuth half a drachm, 
carbonate of magnesia two scruples, syrup of 
ginger half an ounce, mucilage acacia half an 
ounce, water two ounces. Give one teaspoon- 
ful four or five times daily. When the colic is 
severe, the parents may be alarmed by the state 
of collapse into which the infant is thrown. In 



248 SIMPLE ATROPHY. 

such cases the child should be placed in a warm 
bath, the bowels relieved by an injection of warm 
water, and a few drops of brandy be given in 
milk or water. On removing the child from the 
bath it should be well dried, a hot meal poultice 
be applied to the belly, and then be well wrap- 
ped up in flannel. If the openings between the 
bones of the skull are sunken, brandy with aro- 
matic spirits of ammonia, or a few grains of the 
carbonate of ammonia should be given. Con- 
vulsions may arise from the above causes, and if 
they should not yield to the ordinary treatment, 
Dr. Graves recommends the following: Oil of 
turpentine one drachm, castor oil half an ounce, 
mixture acacia and cinnamon water each three 
ounces ; mix and give one teaspoonful every 
four hours. This acts upon the bowels, and also 
produces free discharge of urine. 

To prevent thrush the mouth should be thor- 
oughly washed after each meal, and when the 
disease has appeared in the mouth some mild 
cathartic should be given, and the mouth should 
be swabbed with the following wash : Chlorate 
of potash half a drachm, borax one drachm, glyc- 
erine one ounce; mix and apply several times 
daily. At the same time this mixture may be 
given internally : Borax one drachm, chlorate 



SIMPLE ATROPHY. 249 

of potash one drachm, simple syrup three 
ounces ; mix and give one or two teaspoonfuls 
three or four times daily. When attacks of 
acute indigestion come on, with hot skin, thirst, 
furred tongue, vomiting and diarrhea, with grip- 
ing pain in the bowels, all food must be stopped, 
and nothing allowed but barley water, or some 
simple gruel. The stomach may be relieved by 
a simple emetic of ipecac, after which rhubarb 
and magnesia may be given to regulate the 
action of the bowels. 

If the diarrhea continues after the tongue has 
become clean, the following mixture will be 
found serviceable : Aromatic sulphuric acid, 
half a drachm, laudanum five drops, syrup of 
ginger half an ounce, caraway water three 
ounces ; mix and give two teaspoonfuls three 
times daily. Milk and lime water may be 
given when the stomach has become less irrita- 
ble, but great care needs to be exercised regard- 
ing the diet for some time afterwards. 



CHRONIC DIARRHEA. 



This disease is a sequel of a large number of 
diseases, but it also conies on as an independent 
affection. When it comes on after some acute 
disease, it is usually attended with more or less 
fever, pain in the belly, a sense of debility, loss 
of appetite, and not infrequently, vomiting. 
The trouble comes and goes irregularly, until 
finally it merges into a chronic affection. When 
the disease assumes the chronic form to begin 
with, there is usually little or no fever. The 
frequency of discharge from the bowels varies 
greatly in different cases, amounting to three or 
four daily in some, while in others there may be 
many more. The stools frequently present an 
appearance as if undigested material was passing 
from the bowels in shape of curds mixed with 
liquid, slimy feces; sometimes with blood if 
there is much straining. The children afflicted 



CHRONIC DIARRHEA. 251 

with this trouble look pale, dull, but yet are 
somewhat active, and partake of food with a 
seeming relish. The disease continues for an 
indefinite period, varying from a few weeks to 
as many mcnths. During the continuance of 
the disease, the child grows paler, thinner and 
weaker, and after a time the discharges grow 
more frequent and liquid, and change their 
appearance often. One day they may be watery 
with a brown color ; at another time, thicker 
and clay colored ; while at other times they will 
consist of slimy mucus and blood. Again they 
present a green color, with an exceedingly offen- 
sive odor, which indicates additional irritation of 
the intestines. The disease is very changeable 
in its character, the changes being influenced 
by diet, changes of temperature, and conditions 
of the atmosphere, as from warm, to cold, and 
vice versa, and from dry to wet. The child 
wastes away, the skin takes on a dirty, yellowish 
appearance, which is quite a constant character- 
istic of the disease, especially after it has been 
of long continuance. 

The .skin is dry and rough, lips pale and thin, 
strength diminishes, so that the child is unable 
to move about, and lies down with no disposi- 
tion to exercise. If the diarrhea still continues 



252 CHRONIC DIAEKHEA. 

it is with greater frequency of discharges, as 
many as fifteen or twenty a day, which are thin, 
watery, of a dirty color, and very offensive. 
The child grows exceedingly weak, the bones 
become prominent, eyes hollow, skin wrinkled, 
and the disease, unless soon controlled, runs to a 
fatal termination. As a result of this disease 
various other disorders are liable to arise, such 
as dropsical affections, congestion of the lungs 
from imperfect circulation, various eruptive 
diseases, convulsions, and disorders of the brain 
from closure of its blood vessels ; and when a 
child dies with chronic diarrhea it is commonly 
from some one of these secondary disorders, as 
a complication. 

In cases where recovery takes place, the first 
improvement noticed is in the character and fre- 
quency of the discharges, the stools becoming 
more solid, and containing more bile. The gen- 
eral bearing of the child is more animated, eyes 
look more brilliant, grows more fretful, cries with 
more strength, and the increase of the secretion 
of tears, usually so scanty in the severer stage 
of the disease, is said to be an exceedingly 
encouraging symptom. The child begins to gain 
in flesh slowly, the stools lose their unhealthy 
character, and the diarrhea ceases. 



CHRONIC DIAEEHEA. 253 

Chronic diarrhea is caused principally by 
unhealthy surroundings, bad sanitary conditions, 
exposure to cold, malarious atmosphere, and liv- 
ing in crowded, ill ventilated rooms, also the use 
of improper, indigestible articles of diet. Not 
infrequently it follows measles, scarlet fever, and 
other acute diseases. Children brought up on 
the bottle are often subject to it from birth, 
and another period when the diarrhea is apt to 
set in is when after nursing a few months other 
food is given which proves a source of irritation 
because the food chosen is of an unsuitable 
nature. The disease is very apt to develop 
itself after weaning, particularly if it take place 
during the summer months. Bad air, want of 
sunlight, and uncleanliness, cause the disease 
quite as often as all other things put together. 

It is amongst the low lived, ill fed, ill housed, 
of our foreign population, that the disease com- 
mits its greatest ravages, and carries off a large 
percentage of their children before they arc two 
years old. Chronic diarrhea is also caused by 
the irritation of the bowels produced by the 
presence of worms ; and where it depends upon 
tubercular disease of the bowels it is exceed- 
ingly fatal. 

Prevention is cheaper, and worth much more, 

22 



254 CHRONIC DIARRHEA. 

than any amount of cure, and here lies our great 
duty, and parents should understand not only 
what causes the disease, but what its preventives 
are. A great deal is accomplished in this direc- 
tion by attention to the diet, and general man- 
agement of the child. As is well known, any 
and all indigestible articles of food as they pass 
through the bowels cause more or less irritation, 
which increases the flow of watery fluid from the 
vessels of the bowels, which induces the diarrhea. 
The rules for feeding children have been alluded 
to at length in the foregoing pages, and no gen- 
eral reference to them is needed here. Stuffing 
children with sweet cake, nuts, fruit and candy, 
between meals, or any other time, is a miserable 
practice, and very injurious. Often is it the 
case that physicians are called to children in con- 
vulsions because they have swallowed green 
apples, pieces of pine apple, or other substances 
better suited to the stomach of an ostrich. 

Exposure to cold, chilling of the blood being 
a fruitful source of the disease, children should 
be dressed warmly, and so dressed that the legs, 
arms and chest, should not be exposed to the 
winds, as is so generally the case. The cloth- 
ing should be changed and made warmer or 
cooler according to changes of the temperature, 



CHRONIC DIARRTIEA. 255 

and flannel should be worn next to the skin of 
infants the year round. 

Fresh air is the best medicine for infants, and 
they should have the full benefit of it by being 
taken out of doors in all suitable weather, and 
that may be said to be in all but damp, wet days. 
Additional care is requisite in guarding against 
chronic diarrhea during the teething period, for 
it is apt to come on at this time in spite of all 
precautions. Exposure to cold, sudden changes 
of temperature, errors in diet, must more than 
ever be avoided. Variations of temperature 
exercise such a notable influence in cases of 
chronic diarrhea in children, that it is highly 
important to maintain an equable temperature 
in the rooms occupied by such patients, which 
should not be too warm, nor too cold, but should 
range from 60 to 70 degrees Fahrenheit. The 
rooms should be well ventilated by night and 
day, except it be in damp weather when it might 
be injurious. The utmost cleanliness should be 
exercised by thorough sponging and drying 
after each stool, and in infants where there is 
redness, soreness and excoriations of the skin 
caused by the frequent discharges, the parts 
should be sprinkled with equal parts of powdered 
lycopodium and oxide of zinc or tannin. The 



256 CHRONIC DIARRHEA. 

napkins, soon as soiled, should be removed, and 
the child's bed and bedding thoroughly aired. 
Chronic diarrhea is kept up and aggravated by 
chills, as is the case in catarrh and colds. The 
feet and legs should be well protected by woolen 
socks and leggins, for cold extremities, particu- 
larly cold feet, have the effect to greatly increase 
the pain and disturbance of the bowels. One 
of the most important items in the management 
of this disease is the proper regulation of the 
diet. Children though suffering severely from 
this affection, often have a vigorous appetite, 
even when the food taken cannot be digested ; 
the child they say * will eat anything," and so 
they give it anything to eat. 

Infants at the breast should be confined to 
the mother's milk, and children brought up by 
hand, who are under six months old, should be 
allowed nothing but equal parts of lime water 
and milk, wine whey, cream or milk and water, 
thickened with isinglass, in the proportion of 
one teaspoonful to four ounces of the milk and 
w r ater. When milk cannot be tolerated, chemi- 
cal food as prepared by Liebig, is especially 
nutritious and answers the purpose admirably. 
Children thrive upon this when almost every- 
thing else in the shape of nutriment is useless. 



CHRONIC DIARRHEA. 257 

The frequency of the meals should be regulated 
according to the necessities and severity of the 
case. The more frequent the discharges from 
the bowels the smaller should be the meals, and 
more frequently given. Where the discharges 
are thin, watery, not more than one or two table- 
spoonfuls of liquid should be given at one time. 
If the child is from six months to a year old, 
heartier food may be given, such as beef tea, 
oyster, mutton and chicken broth. Extract of 
beef, with iron and wine, may be useful when 
the diarrhea is checked, to impart tone and 
strength to the system. Where the patient is a 
year old, boiled flour cooked in milk, canna 
farina, arrowroot, tapioca and sago, are useful, 
but small quantities should be given at a time. 

The nutrition of the body must be sustained 
with as little demand upon the powers of diges- 
tion as possible, in order to avoid irritating those 
organs in their peculiarly sensitive condition. 

Where the discharges from the bowels present 
a putty, or clay colored appearance, milk should 
be avoided, and the following diet, recommended 
by Eustace Smith of the London Hospital, may 
be used, and will be found of great usefulness : 
First meal, one teaspoonful of Liebig's food for 
infants dissolved in four ounces of milk and 

22* 



258 CHRONIC DIARRHEA. 

water, equal parts. Second meal, four ounces 
of* beef tea, of the strength of four ounces of 
the fillet of beef to a pint of water. Third 
meal, four ounces of whey, to which is added a 
teaspoonful of cream. Fourth meal, yolk of 
one egg, beaten up with a tablespoonful of cin- 
nanon water, a little white sugar, and ten drops 
of pale brandy. Fifth meal, the same as the 
first. It is always better that the child should 
go a little hungry, than that its appetite should 
be entirely satiated. 

The skin in chronic diarrhea is inactive, and 
therefore external applications are serviceable. 
The warm bath may be used every night, after 
which the whole body should be anointed with 
warm olive, or camphorated oil, the child wrap- 
ped in flannels and placed in bed, and in cases 
where there is much prostration, the mustard 
bath should be used. When there is danger of 
ulceration of the bowels, it is advisable to envelop 
the . bowels in a good sized poultice, applied 
warm, which may be prepared with equal parts 
of flaxseed meal and mustard. The poultices 
should be changed often, care being taken not 
to chill the patient, or dampen the clothing, 
while using them. 

The internal remedies used for this disease 



CHRONIC DIARRHEA. 259 

have differed greatly with different physicians, 
one strongly advocating one plan of treatment, 
another equally enthusiastic over a different 
course, and so on, perhaps the one plan proving 
quite as successful as the other. 

If the child is seen early in the disease, before 
the diarrhea is fully developed, and there is pale- 
ness, loss of flesh, straining and pain, with sour 
smelling stools, a small dose of powdered rhu- 
barb and carbonate of soda may be given, and 
after this has acted upon the bowels, the follow- 
ing mixture will be found useful : Laudanum ten 
drops; bicarbonate of soda, two scruples; simple 
syrup and caraway water, each one ounce ; a 
teaspoonful of the mixture to be given three 
times a day. Laudanum with castor oil is useful 
in many esses, especially if the tongue is coated, 
and may be used as follows : Laudanum, sixteen 
drops; castor oil, two drachms; syrup of ginger, 
half an ounce ; mucilage acacia, an ounce and a 
half. Mix and give one teaspoonful four or five 
times daily. 

When the diarrhea sets in with green, slimy, 
watery stools, with a sour odor, this mixture 
may be given ; subnitratc of bismuth, one scru- 
ple ; pulverized chalk, two scruples ; simple syrup 
and cinnanon water, each an ounce and a half; 



260 CHRONIC DIARRHEA. 

one teaspoonful to be given every three or four 
hours. If there is much straining at stool, a 
drop of laudanum, or three or four drops of the 
syrup of ipecac, may be added to each dose, the 
doses always to be increased in proportion to 
the age of the child. Should the tensemus or 
straining be severe, a mixture of a teacupful of 
starch water and five or six drops of laudanum 
may be injected into the bowels, and the opera- 
tion repeated three or four times daily. If the 
diarrhea continues after the tongue is clean, 
stringent remedies are called for, and this strin- 
gent compound will be found effectual in many 
cases : Tincture krameria, and tincture of cate- 
chu, each two drachms, laudanum ten drops, 
simple syrup two ounces ; mix and give one tea- 
spoonful every three or four hours. Another 
mixture is as follows : Sugar of lead ten grains, 
dilute acetic acid twenty drops, laudanum twelve 
drops, tincture of kino two drachms, syrup of 
ginger two ounces; mix, and give one teaspoon- 
ful every six hours. 

The following astringent mixtures, used and 
recommended by Dr. Eustace Smith of the Lon- 
don Hospital for sick children, will be found of 
special service in the chronic diarrhea of chil- 
dren : Gallic acid one scruple, aromatic sulphuric 



CHRONIC DIARRHEA. 261 

acid half a drachm, laudanum ten drops, spirits 
of nitre half a drachm, simple syrup one ounce, 
water two ounces ; mix, and give one teaspoon- 
ful every four or six hours. Another mixture 
is : Tincture of capsicum six drops, simple syrup 
half an ounce, decoction of logwood one ounce 
and a half; mix, and give one teaspoonful every 
four hours. 

In many obstinate cases of chronic diarrhea, 
nitrate of silver is useful after all other means 
have failed, and it may be given by the mouth, 
or by injection into the bowels, or both. It may 
be given internally in this form : nitrate of sil- 
ver one grain, dilute nitric acid five drops, mu- 
cilage and simple syrup each six drachms ; mix, 
and give one teaspoonful every four or six hours. 
When given as an injection add five grains of 
the nitrate of silver, and five drops of laudanum, 
to a teacupful of starch water, and inject the 
whole at once, repeating the process three times 
a day if needed. The above mixture for inter- 
nal use is very useful in cases where there is 
great loss of flesh, frequent stools, which contain 
mucus and blood. In cases where the stools are 
slimy, with lumps of bloody mucus, resembling 
lumps of flesh, the bichloride of mercury given 
after the following formula, will be beneficial : 



262 CHRONIC DIARRHEA. 

Bichloride of mercury, one grain ; water, half a 
pint ; mix and give one teaspoonful every hour 
or two. When the child continues to grow worse 
and the prostration is very great, stimulants 
will be demanded. From five to ten drops of 
pale brandy, or twice the quantity of sherry 
wine, way be given in milk several times a day, 
the dose to be increased according to the neces- 
sities of the case. In some cases the diarrhea 
continues in spite of all treatment, in which 
cases all common food must be stopped, and the 
child be nourished by the use of raw beef pre- 
pared in the following manner : A piece of beef 
steak, free from fat, should be finely cut, and 
pounded to a jelly, season with salt, and give 
one or two teaspoonfuls of it three or four times 
a day, increasing the amount each day, until it 
is borne in considerable quantity, allowing no 
other food whatever while using it, except it be 
barley water, or something of that nature for 
drink. Bismuth and lime water, or chalk with 
a drop or two of laudanum, may be given before 
each meal while using the meat diet. After the 
diarrhea is arrested by this treatment, tonic 
remedies will be found useful in giving strength 
and tone to the debilitated organs. Among the 
most useful may be mentioned the various prep- 



CHRONIC DIARRHEA. 263 

arations of iron, quinine, cod liver oil and calis- 
aya bark with wine. The pernitrate of iron is 
highly spoken of, given after this formula : solu- 
tion of the pernitrate of iron half a drachm, 
dilute nitric acid half a drachm, syrup of gin- 
ger one ounce, cinnamon water three ounces ; 
mix and give one teaspoonful every four or six 
hours. In giving cod liver oil, begin with small 
doses, say ten drops in a tablespoonful of milk, 
three times daily, but if the oil can be detected 
in the passages from the bowels, by odor or oth- 
erwise, then omit it for a day or two, or give 
smaller doses. 



CHRONIC VOMITING. 



Vomiting, more or less severe, is exceedingly 
common in infancy and childhood. Nearly all 
infants while at the breast are subject to slight 
attacks of vomiting, which last from one to sev- 
eral days as the case may be. The matters 
thrown up are the food, mucus and bile. There 
is with the vomiting heat of skin, furred tongue, 
and either constipation or diarrhea, the latter 
being more frequent. These simple attacks re- 
quire but little attention, beyond relieving the 
stomach with an emetic of the wine or syrup of 
ipecac, followed by some mild cathartic, and 
proper attention to diet afterward. 

When the disease becomes chronic, attended 
with loss of flesh, and great prostration, it be- 
comes a serious matter, requiring close watch- 
ing and constant care. The symptoms of chronic 
vomiting are as follows : there is little or no 






CHRONIC VOMITING. 265 

fever, the child vomits at irregular intervals, 
throwing up curdled milk with a sour, sickening 
odor, tinged green or yellow with bile. Soon 
the bile disappears from the matters rejected by 
the stomach, and a clear, watery fluid takes its 
place. Tenderness over the pit of the stomach 
is noticed by pressing the hand upon this local- 
ity. The stomach is often distended with gas, 
and rumbles when pressed upon ; the gases are 
raised from the stomach in considerable quanti- 
ties. The bowels are apt to be constipated in 
the severer cases ; the tongue is heavily coated ; 
the breath has a sour smell ; the lips are dry 
and red ; the mouth dry and parched ; the child 
nurses eagerly, but soon vomits all the milk 
taken. Cases may continue on for some time in 
this way without any great change for the bet- 
ter or worse, but finally the vomiting grows 
more frequent, occurring not only after taking 
food, but during the intervals, and the milk taken 
is thrown up without being curdled. The child 
now loses flesh very rapidly ; the skin is dry ; 
flesh is loose and flabby ; eyes are dark and 
sunken ; nose sharp ; cheeks hollow; child lies 
with its legs drawn up, occasionally moving them 
as if in pain ; is very fretful ; cries out suddenly, 
and is wakeful night and day. The tongue now 



266 CHRONIC VOMITING. 

becomes dry, coated, rough, presenting a granu- 
lar appearance. The vomiting still continuing, 
the child becomes terribly reduced in flesh ; 
body is cold and pale ; hands and feet purple ; 
vomiting occurs if the patient is simply moved 
about. The child lies in a dull, stupid state, 
with eyes half closed, and breathing is the only 
evidence of remaining life. Thrush now appears 
in the mouth, which is a pretty sure indication 
that the disease will soon end in death. 

Trouble with the head often results from these 
long continued cases of vomiting, death fre- 
quently resulting from some secondary disease 
of the brain. 

When children recover from this disease, the 
vomiting gradually grows less and less frequent, 
until it ceases altogether, and it is necessary to 
be very careful about giving much food for some 
time after the trouble has disappeared. 

There are various causes for this troublesome 
affection, such as, premature weaning, giving 
indigestible food ; crowding children into ill 
ventilated rooms, where there are several per- 
sons, as is so often the case in the apartments of 
the poor ; and overfeeding by too frequent nurs- 
ing. In the management of this disease certain 
rules and precautions need to be enforced. In 



CHRONIC VOMITING. 267 

the vomiting of infants at the breast, the qual- 
ity of the milk should be examined, the quantity 
taken must be so regulated that a child shall get 
but a comparatively small allowance at a time, 
and for a while after nursing, the infant must not 
be subjected to any violent movements, like swing- 
ing or rocking, as these movements are often 
sufficient to excite nausea, and vomiting, when 
the stomach is full. If the infant has been pre- 
maturely weaned, it is sometimes advisable to 
procure a wet nurse, if one can be obtained with 
good milk, suitable to the necessities of the child, 
but if the milk should fail to agree with the 
patient, the nurse should be changed. Where 
children are greatly reduced and prostrated, the 
mere act of nursing seems to excite vomiting, 
in which case the milk of the nurse should be 
drawn, and fed to the infant with a spoon. If a 
wet nurse is not to be had, equal parts of milk 
and lime water is to be substituted. 

Liebig's food for infants, prepared in milk and 
water, a teaspoonful to four ounces, is an excel- 
lent substitute for milk in many of these cases, 
an 1 is well borne when milk is not tolerated. 
All food should be given hot or cold, as luke- 
warm articles are more apt to prove nauseous. 

The 'infant should be warmly clad, a flannel 



268 CHEONIC VOMITING. 

bandage should be applied around the belly, and 
the patient kept in a room comfortably warm. 
Warm applications should be made over the stom- 
ach, and they may consist of flaxseed or poppy 
leaf poultices ; fine salt thoroughly warmed, 
placed in a bag and laid on ; or a liniment of 
equal parts of camphorated oil and chloroform 
liniment, or a liniment made of equal parts of 
compound camphor and soap liniment. Warm 
mustard baths followed by thorough friction are 
beneficial. For the vomiting which often attacks 
infants from irritability of the stomach, without 
any special exciting cause, Dr. Bednor advises 
relieving the stomach with teaspoonful doses of 
the wine of ipecac. After the stomach has been 
emptied of its acid secretions, it is best to give 
some alkaline and sedative mixture, like the fol- 
lowing : Lime water, two ounces ; white sugar, a 
tablespoonful ; mix and give one or two tea- 
spoonfuls three or four times daily ; or carbon- 
ate of soda, ten grains ; bismuth, twenty grains ; 
white sugar, two tablespoonfuls ; water, two 
ounces ; mix and give a dessert-spoonful every 
three hours. The following is sometimes very 
useful : Subnitrate of bismuth, one scruple ; car- 
bonate of magnesia, half a drachm ; oxalate of 
cerium, ten grains ; tincture capsicum, ten drops ; 



CHRONIC DIARRHEA. 269 

simple syrup and mucilage tragacanth, each half 
an ounce, water two ounces ; mix and give one 
teaspoonful every hour or two. 

In chronic vomiting the bowels are almost 
always constipated, and should be relieved by 
some simple laxative medicines, or by stimulat- 
ing injections. A gill of warm salt and water 
may be injected into the bowels once or twice a 
day, or ten grains of powdered aloes in a tea- 
cupful of boiled milk. Ten or twelve drops of 
the tincture of aloes may be given once or twice 
a day in a little syrup, if it can be retained upon 
the stomach long enough to take effect. Small 
doses of the mild chloride of mercury, from one- 
eighth to one-sixth of a grain, placed upon the 
tongue every four hours, afford frequent relief. 
Dr. Eustace Smith of the London Hospital rec- 
ommends the following mixture : Dilute hydro- 
cyanic acid, six minims ; nitrate of potash, one 
drachm ; simple syrup, half an ounce ; water, 
an ounce and a half; mix and give one teaspoon- 
ful three times daily. A drop of laudanum may 
be added to each dose, if the vomiting is obsti- 
nate. One drop doses of the wine of ipecac, or 
of Fowler's solution, given in a teaspoonful of 
water every five or six hours is said to cure vom- 
iting not relieved by other remedies. 

23* 



270 CHRONIC VOMITING. 

In some of the cases where vomiting contin- 
ues after the tongue presents a healthy appear- 
ance, stimulants should be given, for in these 
cases the vomiting is often the result of debility 
of the stomach. The following formula for their 
use will answer : Aromatic spirits of ammonia 
and spirits of chloroform, each half a drachm ; 
syrup of tolu, half an ounce ; decoction cinchona 
bark, two ounces ; mix and give one teaspoonful 
three times daily. Or, dilute nitric acid and 
spirits of nitre, each half a drachm ; tincture 
capsicum, ten drops ; syrup of ginger, half an 
ounce ; caraway water two ounces ; mix and 
give a teaspoonful every four or six hours. 
These remedies should be used for some little 
time after vomiting ceases. 



EICKETS. 



This disease results from want of proper 
assimilation of the food taken into the system, 
and the consequent imperfect nutrition of the 
body. Its commencement is hardly noticeable, 
the simple symptoms of impaired nutrition being 
all that marks the onset of the affection. There 
is a gradual diminution of strength, and reduc- 
tion of all the vital forces, resulting in the gen- 
eral innutrition of the whole system, so that 
any disease thus operating to derange the func- 
tion of nutrition may lead on to rickets, in which 
the bony structures become softened, so that 
their natural shape is very much changed by the 
action of the muscles attached to them, or by 
the limbs bending, being unable to support the 
weight of the body. It is emphatically a disease 
of childhood, and most generally develops itself 
during the second and third years of life, when 



272 RICKETS. 

children are beginning to walk. Among the 
early symptoms indicating the approach of rick- 
ets are the following : The temperature of the 
body is exalted, there is a general feverish con- 
dition of the body ; often a profuse perspiration 
of the head, neck and chest, which continues by 
day as well as night ; and if the child falls 
asleep the sweating is increased so as to wet the 
pillow, and while awake the least exertion in- 
creases the difficulty. * 

The superficial veins of the face and forehead 
are large, full and prominent, and while this 
portion of the body is covered with sweat, the 
abdomen and lower limbs may be dry and hot. 
The child, in trying to keep cool at night, will 
kick the clothing off as often as it is put on. 

These general symptoms of weakness and 
relaxation come on prior to the malformation of 
the bones. Before much deformity takes place 
there is usually discernable a general tenderness 
upon the surface of the body, the child mani- 
festing discomfort when it is tossed up and down 
in the arms of its mother, becomes cross and 
fretful on being touched ; and is comparatively 
easy when sitting or lying down, as all move- 
ments seem to give rise to pain and general 
uneasiness. The bowels are more or less in- 



KICKETS. 273 

volved in the general derangement, constipation 
generally existing, though at times there is 
swelling of the abdomen and diarrhea. The 
food taken passes through the bowels with but 
little change. The appetite is often voracious, 
children being hungry soon after eating a hearty 
meal. The child soon loses its power of walk- 
ing, and either sits or lies down most of the time, 
grows dull, stupid, and loses flesh. 

The long bones, such as the spine and bones 
of the legs, are apt to bend under the weight of 
the body, head increases in size, face looks small, 
features less prominent, breathing becomes more 
frequent, and the pulse small and more rapid. 
The bones also become soft, the earthy matter 
being diminished while the animal matter is in 
excess. The lower extremities are the first 
involved in distortion, owing to the weight of 
the body, so that the child as a consequence 
becomes bow legged. Later in the disease there 
is deformity of the spine and chest, producing 
curvature of the spine and pigeon breast. Sir 
William Jenner in his lecture on rickets men- 
tions the following as the most constant changes 
that take place in this disease : Enlargement of 
the ends of the long bones, where the bones and 
cartilage are in contact, viz., when the cartilage 



274 RICKETS. 

is read} 7 for ossification, and when bony harden- 
ing is taking place in the cartilage ; softening of 
all the bones ; thickening of the flat bones, as 
the bones of the skull, shoulder blades, and pel- 
vis. Deformities which follow from mechanical 
causes acting upon the softened bones, thus giv- 
ing rise to deformities of the chest, pelvis, spine, 
and all the long bones, as those of the arms and 
legs. All these deformities may be present in a 
single case, but it would be the exception and 
not the general rule, for the degree of deformity 
is very variable in different cases. The changes 
that take place in the different bones are about 
as follows : The skull is much increased in size, 
and its general shape altered, being longer from 
before backward than natural. The openings 
between the bones of the skull are open much 
wider than usual, and they remain open for a 
much longer time than is usually the case. 

The top of the skull is flattened, and the sut- 
ures, or lines of union between the bones, are 
expanded and separated. The forehead is high, 
square, projecting, and out of proportion to the 
face. The bones of the face are arrested in their 
growth, so that while the forehead is larger the 
face is smaller than usual. 

The head presents much the same appearance 



RICKETS. 275 

as in dropsy of the brain, or hydrocephalus, 
but there are distinguishing symptoms, which 
can be detected by physicians familiar with the 
two affections, which could not or would not be 
readily observed by any non-professional ob- 
server. 

A curious condition of the skull known as 
cranio tabes, sometimes exists, which was first 
detected by Elsasser, and is well described by 
Dr. Alford Vogel of Munich. 

On resorting to gentle pressure upon all of 
the posterior surface of the head, spots can be 
found where the bone is much thinner than nat- 
ural, and is soft and elastic to the touch, and 
there is a depression, which varies according to 
the size or extent of the thinning. The usual 
size of these spots is said to be from that of a 
flaxseed to a bean, though they have been found 
much larger, and the most frequent seat of them 
is on the occipital bone. The portion of the 
bones not involved is much thicker than in the 
natural, healthy skull. A case of this peculiar 
affection of the skull in a man of thirty or more 
years of age, has occurred during the past year 
in the practice of one of our resident physicians. 
When occurring in infants the disease arrests the 
process of teething, so that if some teeth have 



276 EICKETS. 

appeared, further progress is stopped, and teeth 
that have protruded turn black and fall out. 

The curvature of the spine is much greater in 
some cases than in others, the deformity being 
dependent upon the extent of the muscular 
debility. 

The direction of the curvature of the spine 
varies according to whether the child can walk 
or not. If the child cannot walk, the anterior 
curvature of the cervical, or upper portion of 
the spine is increased, and there is a posterior 
curvature in the small of the back. If the child 
is able to walk, the dorsal portion of the spine 
is curved backwards, the lumbar portion for- 
wards. In other cases the spine curves laterally, 
though this curvature is the least common. 

The chest is gradually deformed, being thrown 
sharply forward. The angles of the ribs and 
their curvatures are very much altered. The 
ends of the ribs are enlarged so that the chest 
presents a rough, uneven appearence, and there 
is recession of the chest in one portion, and 
bulging in another, producing ridges and fur- 
rows, leaving almost no regularity of surface. 
The collar bone, or clavicle, and the bones of 
the arm, are bent by the action of the muscles 
attached to them. The shoulder blade is said to 



RICKETS. 277 

be often so much thickened as to interfere with 
the motions of the shoulder. The bones of the 
pelvis are very much distorted. The thigh bones 
are curved forward, if the child is unable to 
walk, but if walking they are curved forward 
and outward. The bones of the leg below the 
knee, are bent outward, so that when a child is 
lifted up, the limbs will be widely separated. 
The deformity of all these bones is very varia- 
ble in different cases. 

The older the child is when attacked with the 
disease, the less liable is it to much deformity, 
and the earlier in life, the greater the deformity 
will be as a rule. 

There is not only deformity of the bones in 
rickets, but they cease to grow and develop, so 
that the whole body is stunted in its growth. 
While these changes are going on, the symp- 
toms spoken of in the fore-part of this chapter, 
are still manifest. There is loss of appetite, ten- 
derness, weakness, perspiration, sickness at the 
stomach, diarrhea, loss of flesh, and the muscles 
still grow thin and flabby. The belly seems to 
be much distended, but it is rather thrown for- 
ward by the deformity of the spine. The face 
looks old, eyes are large and sunken, breathing 
is difficult, the child appears stupid, and mani- 

24 



278 EICKETS. 

fests no disposition to play or exert itself in any 
way, grows pale, and often presents a waxy, 
green, or yellowish appearance. 

Owing to the great debility of the system, 
secondary diseases are apt to accompany, or fol- 
low rickets, and often with a fatal result, such 
as catarrhal troubles, bronchitis, pleurisy, diar- 
rhea, convulsions, and dropsy of the brain, all 
of which are much more likely to prove fatal, 
than when occurring as independent affections. 
In the treatment of this disease, our first aim 
must be to remove the cause which created the 
disease, and is maintaining it in force. The 
houses occupied should be in dry, healthy local- 
ities, where there is plenty of sunlight, pure air, 
and the rooms in which the child lives and sleeps 
should always be thoroughly ventilated. One 
of the first and most important things to accom- 
plish is healthy nutrition, which is brought about 
by due attention to diet, and sanitary and hygienic 
measures, taking care to correct any derange- 
ment of the digestive organs which may inter- 
fere with the digestion, and assimilation of food. 
Often the bowels are relaxed, there being three 
or four stools a day, the discharges being like 
putty mixed with mucus and blood, and very 
offensive. It is advisable to commence treat- 



EICKETS. 279 

merit by giving some gentle laxative, as a tea- 
spoonful of oil, rhubarb and soda, or magnesia, 
and after the bowels have been thus acted upon 
alkaline remedies may be administered as fol- 
lows : Laudanum, twelve minims ; bicarbonate 
of soda, one drachm and a half; aromatic spirits 
of ammonia, one drachm ; syrup of ginger, half 
an ounce ; cinnamon water, three ounces ; mix 
and give two teaspoonfuls three times daily. 
Under this treatment the motions of the bowels 
will become much more healthy, and the griping 
pains will cease. The diet must be regulated 
according to the digestive powers of the patient ; 
plenty of fresh air is indispensable, and rickety 
patients should be taken out into the open air 
as often as the weather will permit. 

Great attention must be paid to clothing and 
cleanliness. The whole body should be well 
washed night and morning, or at least once a 
day, with warm salt and water. The bedding 
used, and room occupied, should be thoroughly 
aired every day. As the functions of digestion 
become regulated, and restored to healthy activ- 
ity, tonic remedies are called for, among the 
most useful of which are cod liver oil, iodine, 
iron, and the salts of soda, potash and lime. 
To infants cod liver oil may be given after the 



280 RICKETS. 

following formula : Cod liver oil and syrup of 
tola, each two drachms ; syrup of ipecac, one 
drachm ; mucilage gum arabic, half an ounce ; 
water, three ounces ; mix and give a teaspoon- 
ful every three hours. Iron may be given in 
either of the following forms : Lactate of iron, 
one scruple ; precipitated carbonate of lime, one 
drachm ; white sugar, two drachms ; mix and 
give as much as can be placed upon the point of 
a pocket knife, three or four times daily to infants. 
For older children, the following may be used : 
Solution of the pernitrate of iron and dilute 
nitric acid, each half a drachm ; syrup of ginger, 
one ounce ; infusion of columba, three ounces ; 
mix and give two teaspoonfuls three times daily. 
Other preparations of iron are useful, such as 
the syrup of the iodine of iron, syrup of the 
phosphate of iron, and reduced iron, or iron in 
powder. Quinine and iron given together are 
valuable, and may be given in the form of citrate 
of iron and quinine, of which three or four 
grains may be dissolved in a little glycerine, and 
given three or four times daily. When cod liver 
oil is given separately, not more than ten or 
twenty drops should constitute a dose. Should 
there be troublesome diarrhea, the following 
mixture may be given : Carbonate of iron and 



EICKETS. 281 

sugar, eight grains ; extract of logwood ten 
grains, white sugar one drachm ; mix and make 
eight powders, and give one every four hours. 
Should there be constipation of the bowels, the 
following laxative may be used : Carbonate of 
iron and sugar, ten grains ; extract of aloes fif- 
teen grains ; extract of gentian, ten grains ; mix 
and make twenty pills, and give one or two pills 
twice a day. For young children the pills might 
be dissolved in a spoonful of syrup. All the 
salts of iron, lime, soda, potash and iodine, are 
useful in restoring the earthy matter of the 
bones. The following mixture is highly recom- 
mended by Dr. Tanner, in his work on children's 
diseases : Phosphate of lime, two drachms ; car- 
bonate of lime, one drachm • lactate of iron, 
twelve grains ; sugar of milk, three drachms ; 
mix and make twelve powders, and give two 
powders a day. 

The first symptoms of catarrhal trouble in 
rickety children should receive prompt atten- 
tion. The whole chest should be painted with 
tincture of iodine, or be thoroughly rubbed with 
some stimulating liniment, and then be enveloped 
in oil silk. For an internal remedy, Dr. Smith 
of the London Hospital advises the following : 

24* 



282 RICKETS. 

Iodide of potassium, five grains ; nitrate of pot- 
ash, one drachm; liquor acetate of ammonia, 
three drachms, simple syrup, one ounce ; cinna- 
mon water, three ounces ; mix and give two tea- 
spoonfuls every four hours. The object is to pro- 
duce as soon as possible a free secretion from the 
bronchial tubes, in order to clear them from the 
tough mucus that is apt to clog them up, caus- 
ing difficulty of breathing. When the cough 
has become loose, a little of the wine of ipecac 
and syrup of tolu, or squills, may be added to 
the mixture. If the patient is weak, a few 
drops of brandy may be given frequently. If 
there is much rattling of mucus in the throat 
and bronchial tubes, when breathing, a tea- 
spoonful of the wine or syrup of ipecac, may be 
given occasionally until vomiting ensues. When 
diarrhea occurs it must be checked as soon as 
possible, on account of the great exhaustion it 
produces. The following rules will serve as a 
guide to treatment in the diarrheal affections. 
If the tongue is coated white or yellow, the skin 
hot, the belly hard, and the passages from the 
bowels are green and slimy, attended with strain- 
ing and griping pains, give the following mix- 
ture : Magnesia, one drachm ; syrup of ginger 






RICKETS. 283 

and mucilage acacia, each half an ounce ; cara- 
way water, three ounces ; mix and give one or 
two teaspoonfuls three times daily. 

If the tongue is coated white or yellow, skin 
hot, belly soft, passages from the bowels pale and 
frothy, and sour smelling, attended with no 
straining, give a mixture of chalk, catechu and 
aromatic confection. If the tongue is clear, 
smooth, motions of the bowels dark, watery and 
offensive, Avith straining, give opium ; and if 
diarrhea continues, lead may be added as follows : 
Sugar of lead, eight grains ; dilute acetic acid, 
twenty minims ; laudanum, six minims ; simple 
syrup, half an ounce ; water, one ounce and a 
half; mix and give one teaspoonful three times 
daily. Should the diarrhea still continue it must 
be treated the same as chronic diarrhea. The 
diet in these secondary affections, must be well 
regulated, and the utmost caution exercised. 



MUCOUS DISEASE. 



This disease is characterized by an increased 
secretion of mucus from the mucous membrane, 
which lines the whole alimentary canal. This 
abundant secretion of mucus deranges the whole 
digestive and nutritive processes. This trouble 
is exceedingly common in the earlier ages of 
life, between two and ten years of age. 

The symptoms of this affection vary much in 
degree of severity ; at first usually slight, but 
becoming more aggravated as the difficulty con- 
tinues. The child grows dull, stupid, is little 
inclined to amusement, or exercise ; grows pale, 
and loses flesh. There is oftentimes drowsiness 
during the day, and wakefulness during the 
night ; the child grinds its teeth, and is disturbed 
by dreams which terrify it. Often the child 
will awake out of sleep uttering loud cries, and 
appear to be in a state of partial unconscious- 



MUCOUS DISEASE. 285 

ness, like those persons who walk and talk in a 
state of somnambulism. The urine is often 
passed involuntarily ; the appetite becomes much 
impaired ; tongue is flabby, with a glossy, slimy 
look ; the bowels are either costive, or there are 
frequent, scanty stools, consisting principally of 
mucus, and attended with straining, and some- 
times diarrhea alternates with constipation. 

The skin is apt to be remarkably sallow, and 
there is generally a jaundiced condition of the 
system. The skin is also inactive, and presents 
a rough, harsh appearance, and the glands about 
the neck are frequently enlarged. There is but 
little regularity about the symptoms, as the 
disease is very changeable ; children one week 
will be feeling comfortably well ; the next, suf- 
fering from pain, diarrhea, vomiting and general 
prostration. It is not unusual to find that chil- 
dren thus affected have an enormous appetite, 
which results from the want of nourishment felt 
in the system, and partly from a morbid craving 
excited by the stimulating effect of the mucus, 
which is present in unusual quantities. Many 
infantile diseases leave behind this condition of 
the mucous secretions. Whooping cough is a 
prominent example of this, the mucous mem- 
brane lining the bronchial tubes secreting a 



286 MUCOUS DISEASE. 

tough, stringy mucus, in large quantities, and at 
the same time there is a free mucus flux from 
the stomach and bowels. The tough mucus that 
is vomited up after a fit of coughing, comes 
principally from the stomach. As the severity 
of the cough diminishes, the symptoms of 
mucous derangement subside. 

The period of second teething is frequently 
attended with this mucous disease, the irritation 
of teething exciting a sympathetic irritation of 
the digestive organs. In order to cure this, as 
well as other disorders of the digestive system, 
the utmost care must be taken regarding the 
diet. Every article of diet which undergoes 
fermentation in the acids of the stomach, or 
bowels, must be discarded. All farinaceous arti- 
cles of food, except stale bread, must be forbid- 
den, and vegetables of all kinds must not be 
used. The child must be kept on meat, milk, 
eggs, &c. ; but a small quantity only must be 
given at once, and the allowance be oft repeated. 
The following is a scale of diet adopted by Dr. 
Smith of the London Hospital for Sick Children. 
First meal : fresh milk diluted with a third part 
of lime w T ater, and a small slice of dry toast, or 
stale bread. Second meal : a small mutton chop, 
or slice of roast mutton, with dry toast, or stale 



MUCOUS "DISEASE. 287 

bread. Third meal : a cup of beef tea, or mut- 
ton broth, or the yolk of a soft boiled egg, with 
dry toast. Fourth meal : same as the first. 
This scale of diet is for a child two or three 
years of age or more. This kind of diet should 
be continued so long as the tongue presents the 
characteristic slimy appearance, or so long as 
there is mucus vomiting, or diarrhea. 

Where the strength has been much reduced, 
stimulants will be useful in improving the 
strength, and the digestive powers. Half a 
wine-glass of pale sherry wine diluted with 
water, may be taken at dinner. Every effort 
should be made to restore healthy .action of the 
skin by frequent bathing, and thorough friction. 
The child should be warmly clad, and exercised 
in the open air. 

Medicines are useful in checking the secretion 
of mucus, and to correct any acidity of the 
secretions that may exist. The bicarbonate of 
soda in some bitter infusion, is beneficial, and 
may be used after this formula : Bicarbonate of 
soda, one drachm ; infusion of Colombo, two 
ounces ; mix and give one-half a teaspoonful to a 
child two years old, three times daily. The com- 
pound decoction of aloes may be given in one tea- 
spoonful doses, two or three times a day, which 



288 MUCOUS DISEASE. 

acts as a tonic to the bowels, and checks exces- 
sive secretion. Sometimes it is well to combine 
a tonic with the decoction of aloes. The citrate 
of iron and cinnamon may be given in the alka- 
line mixture, or a teaspoonful of the wine of 
iron may be added to each dose of the decoc- 
tion of aloes. Another useful mixture is as fol- 
lows : Tartrate of iron and potash, one drachm 
and a half; compound decoction of aloes two 
ounces ; water, six ounces ; mix, and give a table 
spoonful two or three times daily. After the 
treatment has been continued for some time, it 
will be noticed that the improvement is less 
rapid than at first, and it becomes oftentimes 
necessary to change from alkaline to acid reme- 
dies, in which case the following mixture may 
be used: Powdered alum, two scruples; sul- 
phate of potash, two drachms ; aromatic sul- 
phuric acid, one drachm ; syrup, one ounce ; 
water, four ounces ; mix, and give one table- 
spoonful three times daily. Where there is 
great loss of flesh, cod liver oil, given in small 
doses before or after each meal, is useful, and 
change of air, and location, results in great 
good. 



WORMS. 



The presence of worms in the intestines of 
children, if not an actual disease, is certainly a 
very frequent source of irritation, which seri- 
ously disturbs the digestive organs and the ner- 
vous system. The varieties of the parasitic 
worms found infesting the stomach and bowels 
of children are as follows : the small thread 
worm, the long round worm, the long thread 
worm, the common tape, and the broad tape 
worm. The small thread worm, or pin worm, 
commonly so called, and the long round worm, 
are the most common species found in children. 

The tape worm is very rarely found in young 
children, and the broad tape worm, though sel- 
dom infesting children in this country, is said to 
be common in other countries. 

The small thread worm varies in length from 
one-sixth to one-third, or one-half an inch, 

25 



290 WORMS. 

These worms inhabit the large intestine, but 
they do not usually trouble children at the breast 
unless artificial food is given besides the breast 
milk, but they are very common in older children. 

The long round worm is much larger than the 
foregoing species, and varies in length from four 
to fourteen inches. This worm lives in the small 
intestine, but often passes into the stomach, and 
is vomited up. This worm is most common in 
children between the ages of three and ten years. 

The long thread worm is from an inch and a 
half to two inches in length, with a long, slender 
neck. This worm also inhabits some portion of 
the large intestine. The common tape worm is 
often of great length, ranging anywhere from 
twenty-five to fifty feet and upwards. It is 
about a third of an inch wide in its widest part ; 
is flat, white in color, and the whole worm is 
made up of a series of joints or segments. 

The broad tape worm is the largest one that 
inhabits the human body, being about an inch in 
width, and many feet in length. The origin of, 
or the way in which these various worms get 
into the human body is not satisfactorily under- 
stood, but it is believed that the round worms 
come from drinking impure water, and there is 
good proof that the tape worm is derived from 



WORMS. 291 

eating meat containing the ova, or eggs, which 
produce the worm. People who eat raw bacon, 
Bologna sausage, rabbits, etc., are especially lia- 
ble to contract the disease. 

The presence of worms in children is usually 
attended by an unhealthy condition of the 
bowels, which comes on after the worms make 
their appearance, and continues even after they 
have disappeared. There is quite a variety of 
symptoms which indicate the presence of worms 
in children. As a general rule the nutrition 
of the body becomes impaired, so that the child 
loses flesh ; the face is pale, and presents often- 
times a puffy appearance ; the lower eye-lids are 
dark and sometimes leaden colored, and the 
pupils are frequently dilated. There is more or 
less itching about the nose and anus, and bleed- 
ing at the nose is not infrequent. The sense of 
smell may be dulled ; the upper lip often swells ; 
the breath is offensive, and in many cases there 
is salivation, the saliva flowing freely from the 
mouth. 

The child suffering from worms grows exceed- 
ingly restless as night approaches ; during sleej3 
it suddenly starts, twitches, grinds its teeth, and 
frequently awakes out of sleep crying and talk- 
ing wildly. There is often a dry, hacking, 



292 worms. 

troublesome cough, together with sighing, sob- 
bing, and hiccough. The belly is more or less 
swollen, sometimes quite hard, and there is more 
or less pain complained of. The appetite is very 
fluctuating, the child at one time having a rav- 
enous appetite, while at another time it will not 
touch food. Sometimes sudden attacks of nausea 
and vomiting come on, during which worms may 
be expelled from the stomach. Diarrhea may 
be present, but the bowels are most usually con- 
stipated. The passage of urine is often difficult 
and painful, and the urine is frequently of a 
white, milky color, owing to the presence of 
mucus. The pulse is small, quick, or slow, as the 
case may be, and irregular ; the temper of the 
child is fretful, and there may be attacks of 
fainting, delirium, or complete stupor. Some- 
times there is loss of voice, cross eyes, or general 
convulsions. According to Dr. Underwood, an 
attack of convulsions, accompanied by small 
pulse and hiccough, is an almost sure sign of 
the presence of worms. 

The presence of the different varieties of 
worms is indicated by certain special symptoms. 
The small thread worm usually causes severe 
itching at the anus, which is most troublesome 
at night, or towards evening, the irritation not 



woems. 293 

only preventing sleep, but causing a great deal 
of discomfort. Another frequent symptom indi- 
cating the presence of pin worms, is tensemus, or 
straining, the desire to go to stool being frequent 
and ineffectual, and the trouble continuing often 
gives rise to a diarrhea. These worms not only 
inhabit the lower bowels, but migrate to other 
organs, and are found to infest the vagina, 
uterus, urethra, throat and stomach. The long 
round worm gives rise to more or less pain, 
which is often located about the navel. This 
worm often passes into the stomach from the 
bowels, causing sudden vomiting, by which it is 
ejected from the stomach. The presence of 
this worm in the intestine is very apt to be fol- 
lowed by unusual nervous derangements, such 
as dizziness, St. Vitus dance, and convulsions. 
The irritation caused by the round worm may 
give rise to diarrhea, and cases are on record, 
where children have had a diarrhea for six or 
eight months, which ceased soon as the worms 
were expelled. 

Tape worms produce sensations of weight and 
gnawing in the belly ; pain, sometimes amount- 
ing to severe attacks of colic, with swelling of 
the belly. Sometimes there is vomiting, diar- 
rhea, headache and lassitude. The presence of 

25* 



294 worms. 

these worms in the bowels is detected by the 
passage of fragments of them in the stools. 
The presence of worms in the passages from the 
bowels is the only satisfactory and positive proof 
of their existence. The great majority of the 
symptoms which are associated with the presence 
of worms may be due to derangements of the 
stomach and bowels, independent of the worms 
themselves. 

The thread worms and the round worms give 
rise to considerable local irritation, but do not 
produce any general disturbance of nutrition, as 
is the case with tape worms, as they cause very 
much emaciation, notwithstanding the patient 
may all the time have a voracious appetite. 

In treating children for worms there are two 
objects to accomplish, viz. : to expel the worms, 
and to restore the bowels to a healthy condition. 
The small thread worms which inhabit the lower 
bowel, or large intestine, are within reach of 
injections, and they afford the most prompt 
relief. Various mixtures may be employed for 
this purpose, such as a strong solution of com- 
mon salt, one tablespoonful to a gill of water ; 
or four or five ounces of the infusion of quassia, 
with twenty drops of the tincture of the muriate 
of iron. 



worms. 295 

An English author recommends for. an injec- 
tion, two scruples of aloes, rubbed up with a 
half a pint of lime water. The injections should 
always be given luke-warm, and at bed-time. 
The diarrhea caused by the thread worms may 
be checked by a simple laxative medicine, as 
follows : pulverized aloes, one grain ; pulverized 
jalap, five grains; pulverized scammony, five 
grains ; syrup of ginger, one ounce. Rub them 
together, and give a tablespoonful to a child four 
years old. A dose of castor oil, or the fluid 
extract of senna and magnesia, will answer the 
same purpose. Where there is great irritation 
of the lower bowel or rectum, a cup of thin 
starch water, to which a few drops of laudanum 
have been added, may be injected before going 
to bed. 

For the long thread, and the long round worm, 
santonine is a useful, and one of the best reme- 
dies, either given alone, or in combination with 
some purgative. It may be given in- powder, 
spread on bread and butter, or syrup, being 
almost tasteless ; or it may be given in form of 
a lozenge ; or after any of the various formulas 
for its use, among which are the following from 
an English author: Santonine, fifteen grains; 
pulverized ginger, five grains ; pulverized jalap, 



296 worms. 

half a clraclim ; sulphur, one drachm and a half; 
confection of senna, one ounce ; mix, make a 
confection, and give a teaspoonful two or three 
times a day. 

Santonine, half a drachm ; mucilage gum 
acacia, one ounce ; compound decoction of aloes, 
six ounces ; mix and give one or two teaspoon- 
fuls two or three times a day. 

In giving santonine alone a good way to admin- 
ister it is to give it in one or two grain doses, 
sprinkled on a piece of bread and syrup, repeat- 
ing the dose two or three times daily, occasion- 
ally giving a laxative to carry off the dead 
worms. The use of this drug often causes a free 
flow of urine, and affects the vision, so that 
objects looked at appear green or yellow. Pink 
root and senna is another remedy much in use, 
and may be given combined w T ith santonine as 
follows : Fluid extract of pink root and senna, 
one ounce ; santonine, eight grains ; mix and 
give from a half to a whole teaspoonful three 
times daily. Some cathartic should be given to 
operate upon the bowels after using any of these 
worm medicines internally to destroy them. 

For the round worm this formula has been 
found effectual : Rectified spirits of turpentine, 
two drachms ; oil of lemon, five drops ; mucilage 



worms. 297 

gum acacia and syrup of ginger each, six 
drachms, annise water one ounce ; mix and give 
one teaspoonful every six hours. 

In young children suffering from tape worm, 
cowhage may be given, followed by some mild 
laxative. For children over eight years of age, 
Dr. Davis of London, recommends turpentine 
given as follows : Oil turpentine, honey, muci- 
lage gum arabic, each one-half a drachm ; water 
half an ounce ; mix and give a teaspoonful 
every two hours. Every second day, give a 
dose of castor oil, magnesia, or rhubarb. 

When children are old enough to fast suffi- 
ciently long, tape worms can be effectually dis- 
posed of in the following way. In the evening 
give the child a cathartic to free the bowels, and 
the next morning after the cathartic has taken 
effect give this mixture : Oil of male fern one 
drachm, simple syrup and mucilage gum acacia 
each half an ounce, cinnamon water one ounce ; 
mix and drink at once. After three hours have 
passed give some laxative to again act upon the 
bowels. A very important part of the treat- 
ment consists in the fact that from before the 
first dose of the mixture given above until after 
the worm is expelled, no food must be taken, 
and but a little drink of any kind allowed. 



298 worms. 

After the worm has been expelled, the diet 
of the patient must be regulated so as to pre- 
vent unhealthy secretions in the bowels, and for 
this purpose alkalies, aloes, and some bitter 
tonics may be given for some time. The bow- 
els should not be allowed to go constipated. 



TUBERCULAR AND SCROFULOUS 
DISEASES. 



The tubercular disease, which consists in the 
deposit of a hard, or soft, cheesy matter in the 
lungs, or the glands of the system, which de- 
velops, and goes on to the destruction of the 
lungs, is very common in children. This disease 
is indicated by certain general symptoms. The 
lungs continually suffer, but not alone, for the 
membranes of the brain, the bronchial and 
mesenteric glands, the external membrane of 
the lungs, the liver, spleen, and in fact almost 
every organ of the body may be involved, or 
affected by the disease. 

The disease may run a rapid course, or may 
become chronic, and many changes are apt to 
take place during its progress. Children who 
are subjects of tubercle present the following 
peculiarities to a greater or less extent : They 
are often tall for their age, and of slight build ; 



300 TUBERCULAR AND 

the skin is delicate, and looks transparent, so 
that the superficial veins of the face, neck and 
hands, are seen plainly through it. The face is 
apt to be oval, and features usually irregular ; 
the complexion is generally clear, though such 
is not always the case, for the face is sometimes 
covered with freckles. 

Children with this diseased condition of the 
system are often remarkably brilliant, precocious, 
good looking, with large, prominent, intelligent 
looking eyes, long eye-lashes, and soft, silken 
hair. The limbs are straight ; wrists and ankles 
small; the nervous system is developed to a 
high degree, and the general organization is 
very delicate. 

Where the constitutional derangement is 
owing to scrofulous, instead of tubercular disease, 
a different appearance of the patient is manifest. 
In these cases the face is generally more rounded 
than oval ; the complexion is dull and pasty 
looking ; the skin is thick, and opaque ; the face 
is not so attractive ; the features are large, lips 
full, and the nostrils expanded. The tongue is 
often large ; the fingers are clubbed or blunt ; 
the belly is large and prominent. In these cases 
the hair and nails grow rapidly ; the skin is 
rough and scaly ; there is a constant secretion 



SCROFULOUS DISEASES. 301 

from the nose ; the skin about the lips cracks, 
and becomes quite sore, and the eyes look weak, 
though they may not be inflamed. This disease 
most always runs a chronic course, and is at- 
tended with the following symptoms : One of 
the earliest symptoms noticed is a want of a 
healthy color of the face, which soon becomes 
quite pale ; the child is dull and listless, but still 
continues to play, though with but little anima- 
tion, and soon tires ; its flesh becomes flabby and 
wastes away. It complains of no pain, but often 
says it is tired ; the appetite appears to be good, 
and so does digestion. Where the disease is 
well marked in children the chest often presents 
a peculiar appearance or shape. The lungs 
being small in proportion to the walls of the 
chest, they adapt themselves to the size of the 
contents. The chest is lengthened, and the 
direction of the ribs much changed. Sometimes 
the chest is long and circular, then again it is 
flattened from before backward. Another shape, 
known as pigeon breast, is said to be owing to 
repeated diseased conditions, or catarrhal affec- 
tions of the lower portion of the lungs, which 
interfere with the proper performance of breath- 
ing. The symptoms here spoken of continue 
for a longer or shorter time • the loss of flesh 
26 



302 TUBEKCULAR AND 

gradually increases ; the cheeks become hollow 
looking ; the eyes sunken ; the bony projections 
more prominent; the skin remains thin and 
transparent, or becomes dry, rough, and yellow- 
ish. The child grows more listless ; is dull and 
inactive ; is inclined to lie down a good portion 
of the time, and complains of its limbs aching. 
The pulse becomes more frequent, and there is 
more or less fever. The appetite may continue 
to be quite good, though very changeable ; there 
is thirst ; the tongue is clear and red, or slightly 
coated. The bowels at one time may be consti- 
pated, while at another time diarrhea may be 
present, the motions being light colored and 
offensive. The wasting and loss of flesh con- 
tinues, and after a time the weakness becomes 
so great that the child keeps its bed, and even 
dislikes to sit up to take its food. The appetite 
now often fails altogether, spots appear upon 
the tongue, gums, inside of the cheeks, and lips. 
The lower limbs become swollen, as well as the 
body, owing to dropsical effusion, which is 
caused by the poor state of the blood. In this 
disease the temperature of the body always rises 
towards evening, as indicated by the thermome- 
ter placed under the arms or tongue. 

The exciting causes which usually determine 



SCROFULOUS DISEASES. 303 

the development of this disease, or the general 
tendencies thereto, consist of anything which 
interferes with the nutrition of the body, 
whether by preventing the introduction of 
nutriment into the system, or by hindering the 
escape of waste material from the body, the 
removal of which is necessary to the proper 
working of the different functions. Such causes 
are impure air, insufficient, or improper food ; 
cold or damp apartments ; want of sunlight, and 
healthy exercise. A combination of these causes 
will in almost any case awaken the dormant 
tendencies to tubercular and scrofulous disease, 
and if these causes continue to operate, will 
produce rapid development of the disease in one 
or other of its several forms. 

Certain diseases of an acute character are 
often the starting point of the chronic constitu- 
tional disorders, as for instance, pneumonia, may 
cause the formation of tubercle in the lung, and 
measles, and whooping cough, may also cause 
the disease to develop in various organs of the 
body. In these instances it is especially the 
lungs and bronchial glands that become involved. 
The tendencies to tubercular and scrofulous 
disease in childhood are so common, that all 
means of prevention should be strictly resorted 



304 TUBEKCULAR AND 

to, and carried out, and certainly there is much 
that can be done to prevent the disease, or at 
least, to retard its progress. 

In all cases where the mother is consumptive, 
she should not allow herself to nurse the child 
longer than the first month, when a healthy wet 
nurse should be provided, unless she decides to 
bring it up by hand, in which case she must 
follow the rules for infant feeding laid down in 
one of the foregoing chapters. The diet of 
older children should be carefully regulated, so 
that no more food should be taken than can be 
readily and thoroughly digested. After the 
child is two years of age it should have four 
meals a clay ; of these, two may be of bread and 
milk ; a third of meat finely cut, or mashed ; 
the fourth of pudding, or an egg softly boiled. 
The milk used should be fresh from the cow, and 
if not, a teaspoonful of cream should be added. 

The skin must be kept clean and active, by 
sponging the whole body with warm water once 
or twice daily. The clothing should be warm 
and loose, with nothing to interfere with the free 
play of the lungs and chest. In selecting a 
house in w T hich to live, a high, dry, airy location 
should be chosen. In the treatment of tubercu- 
losis certain things are important. As before 



SCEOFULOUS DISEASES. 305 

mentioned, a free supply of fresh air is one of 
the first requisites. Moderate exercise, not 
amounting to fatigue, and plenty of nutriment, 
are necessary. The child should pass as much 
time out of doors as possible, during the day, 
but should not be out of the house after sun- 
down. Cold is less injurious than dampness, 
therefore due caution should be exercised in this 
respect. The child should be dressed warm 
enough so as not to be chilled on going out, and 
flannels should be worn next to the skin the 
year round. The condition of the bowels needs 
to be looked after, and constipation overcome 
whenever it exists. The most common condi- 
tion of the bowels in these diseases is one where 
the bowels are relaxed, with three or four light 
colored, offensive stools a day. In the latter 
case the following mixture may be given : Tinc- 
ture of opium, twenty-four minims ; aromatic 
sulphuric acid, one drachm ; tincture of myrrh, 
one and a half drachms ; syrup of orange peel, 
one ounce ; infusion of orange peel, six ounces; 
mix and give one teaspoonful three times a day. 
Or the following : laudanum, twenty-four drops; 
castor oil, three drachms ; syrup and mucilage 
gum arabic, each one ounce ; peppermint water, 
six ounces ; mix and give two teaspoonfuls three 
26* 



306 TUBERCULAR DISEASES. 

times a day. Tonics, as iron, quinine, cod liver 
oil and iodine, are very beneficial. In giving 
cod liver oil, one or two teaspoonfuls may be 
given before or after each meal, unless some of 
it passes off through the bowels in an undigested 
state, in which case the dose must be diminished. 
In the scrofulous affections of the glands, with 
swelling and softening, iodide of iron, iodide of 
potassium, preparations of bark, quinine and 
wine are highly beneficial. 



FOLLIES OF DRESS, AND EVILS PER- 
TAINING TO THE SEXES. 



"When we consider that a great proportion of 
children's diseases result from exposure in one 
way and another, it is not at all to be wondered 
at, that the mortality of children between the 
ages of one and fifteen years is so great. While 
in infantile life being unable to walk, and con- 
fined as they are most of the time in the house, 
like hot house plants, it matters not so much if 
children have but little covering over their neck, 
chest and limbs, but the way children are dressed, 
especially girls, between the ages of five and 
twelve years, who are out upon the street every 
day in cold winter weather, is productive of 
physical evils, that often result in serious con- 
stitutional diseases. 

Girls between the ages mentioned above may 
be seen any day upon the street, during the 
coldest weather in winter, with dresses so short 



308 FOLLIES OF DRESS, AND EVILS 

that the skirts only come down to their knees, 
with nothing on the limbs below, but a pair of 
woolen or cotton hose, and not unfrequently 
children are seen where the hose and other 
clothing do not meet into two or three inches, 
leaving a portion of the limbs actually uncov- 
ered and unprotected. 

Let an adult man, or woman, travel around 
the streets on a cold wintry day, with pants or 
dress cut off at the knees, with no protection 
for the limbs but a thin pair of hose, and how 
do you suppose they would look, and do you 
suppose they would feel very warm and com- 
fortable ? Would there not rather be an unpre- 
cedented lot of swollen, stiff, rheumatic joints, 
aching bones, restless nights, and many cases of 
people made prematurely decrepid and useless, 
or helpless ? 

Equally absurd, and as much to be denounced, 
is the practice of wearing low neck dresses, 
exposing the upper part of the chest to wind 
and storm. Within a year or two past girls 
have approximated the primitive style of wear- 
ing no clothing at all, as near as the rules of 
decency and propriety would permit, but either 
the climate was fatal to the fashion, or its un- 
popularity caused it to become extinct. 



PEETAINIXG TO THE SEXES. 309 

The practice so extensive of bundling up the 
neck with furs, scarfs, or comfortors, is injurious 
for the following reason : Where a person has 
once become habituated to their use, it will 
never do to leave it off on going out of doors, 
for in this event a " cold " will almost surely 
result, and all persons who thus keep their necks 
wrapped up, and in more or less perspiration, 
are much more subject to diseases of the throat 
and lungs, than those who never wear them. 
Persons who have been in the habit of keeping 
their necks thus bundled up, but who have after- 
wards accustomed themselves to do without the 
extra covering, have often remarked that since 
discarding the scarfs and fur collars, they have 
been freer from coughs, colds, and throat 
diseases, than ever before. 

There is a golden mean between wearing noth- 
ing at all upon the chest and about the neck, 
and the superabundant covering sometimes put 
on, which should be appreciated and adopted. 

These evils of dress, it would seem, might be 
easily overcome, and in one sense they are, and 
in another they are not. It would be an easy 
thing to do to cut the dress skirts longer, and to 
cover the limbs with leggins of cloth or worsted, 
which would be an easy remedy. But to remedy 



310 FOLLIES OF DRESS, AND EVILS 

this evil of dress, you have much to contend 
with, for fashion is one of the hardest things to 
overcome. There is almost no independence in 
dress, and whatever fashion dictates, however 
absurd it may be, its votaries attentively and 
obediently worship at her shrine. It is to be 
hoped however, that the day will ere long dawn 
when a little more sense, and far less nonsense, 
will be displayed in matters of dress, so that the 
young will be not only covered, but well pro- 
tected against cold, and sudden changes of tem- 
perature. 

Another source of evil is the want of proper 
parental instruction while young, regarding the 
functions, proprieties and improprieties of the 
sexes. It seems to have been the idea of the 
popular mind that young girls and boys should 
not be spoken to about sexual evils, or fore- 
warned of any abuses and pernicious habits that 
they might Ml victims to for want of a little 
wholesome instruction, for fear that by so doing 
the subject would be prematurely brought to 
their attention, and so do more harm than good. 

The same rule of action has kept mothers 
from giving their daughters timely advice con- 
cerning the menstrual function, when it is to be 
expected, what it is, and what precautions are 



PEETAINING TO THE SEXES. 311 

requisite at such periods. Now the idea that it 
is too delicate a question to bring to the atten- 
tion of boys and girls of eight or ten years of 
age, is perfectly absurd, for if parents do avoid 
any allusion to the subject, and fail to give them 
proper instruction, they need not flatter them- 
selves that the younger members of the family 
are kept in ignorance of the subject. The great 
majority of the youths that attend the common 
schools are thoroughly posted about the evil 
practices, the very things that they should be 
early instructed about by their parents, that 
they may be taught to avoid them. 

It is often the case that people allow false 
modesty to run away with their health. It is 
well for parents to remember that the girls and 
boys are exceedingly precocious as regards these 
questions of the procreative functions, and that 
if they do not receive proper enlightenment 
from their parents, they certainly will receive 
improper information from people and older chil- 
dren with whom they are brought in contact 
daily. 

For the physical and moral well-being of their 
children, every parent should thoroughly instruct 
them about the proprieties and improprieties, 
the uses and abuses, of the sexual relations and 



312 FOLLIES OF DRESS. 

functions ; and instead of resulting in evil by 
any premature knowledge of the subject, it 
would result in great good, by warning the 
young, none too soon, of the dangers that lay 
in their pathway in life. 

If every father will early enlighten his sons 
upon everything bearing upon this subject, 
using plain, outspoken language, telling them 
what to do, and what not to do, we venture to 
say that a more vigorous, robust and moral set 
of men will be the result. 

If every mother will do the same by her 
daughters, there will be a far less number of 
young ladies who are physical wrecks before 
they are twenty years of age, pale, bloodless, 
suffering from weakness, palpitation, neuralgia, 
hysteria, and all manner of nervous and uterine 
disorders. Let this plain and healthy advice be 
given then, without fear of evil, with the full 
assurance that the moral and physical well-being 
of your children demand it. 



SURGICAL DISEASES AND DEFORMITIES 
OF CHILDREN. 



The deformities to which children are subject 
are various, and are both congenital and ac- 
quired, among which may be mentioned, club- 
foot, hare-lip, cleft palate, rupture of the bowels, 
or navel, bow-legs, knock knees, tongue tie, and 
a great variety of mal-formations. 

Many deformities of this class are allowed to 
continue, without any efforts being made to 
remedy the evil, and so the person is afflicted 
for life. Whether this neglect arises from the 
belief that nothing can be done for the child, or 
from some other reason, I know not ; but one 
thing is certain, viz., that the neglect to remedy 
these several deformities of infancy is unpar- 
donable. The various surgical diseases and 
deformities will be treated of separately, the 
operations required will be explained, and the 
different mechanical appliances resorted to to 
overcome the malformations will be described. 

27 



TONGUE TIE. 



It is very frequently the case that children 
are born with the tongue attached by nearly all 
of its under surface to the floor of the mouth, 
so that sucking, and many other movements are 
prevented. The fraenum, or narrow tendinous 
band that is attached to the bottom of the 
tongue, frequently extends almost to the tip of 
the organ, whfch is the malformation usually 
designated tongue tie. The trouble is easily 
remedied by raising the tongue, and dividing the 
fraenum for an eighth of an inch or so, with a 
pair of blunt pointed scissors. Care must be 
taken to cut close to the floor of the mouth, so 
as to avoid wounding the artery. 



CLEFT PALATE. 



This deformity of the mouth and palate is 
very variable in its extent ; sometimes the uvula 
only may be divided, while in other cases the 
hard palate, or roof of the mouth, will be divided 
also, and occasionally the deformity will extend 
to the face, producing hare-lip. The most fre- 
quent cases are .those where the soft palate and 
uvula are cleft, without the hard palate being 
involved. The inconveniences arising from a 
fissured palate are, difficulty in swallowing, the 
fluids often being forced up the posterior nos- 
trils, producing more or less strangulation ; and 
talking, which is rendered imperfect, indistinct, 
the voice, or speech, being nasal. 

The deformity is readily overcome by means 
of an operation, the only question regarding the 
propriety of the operation being as to the best 
time of life to perform it. As the success of 



316 CLEFT PALATE. 

the operation depends upon the quiet and tran- 
quility of the patient during its performance, 
and also during the healing process, some sur- 
geons advise postponing the operation until the 
child is old enough to comprehend what is re- 
quired of it, in order that it be taught to take 
the needful precautions against movements of 
the throat and palate. 

The operation consists in the first place of 
dividing the various muscles of the palate, which 
are concerned in its movements ; and secondly, 
in paring the edges of the fissure. After the 
bleeding is arrested, the edges of the palate 
which have been pared, are brought together, 
and kept so by means of stitches properly intro- 
duced. After the operation, the patient must 
be put to bed, and every possible care used to 
prevent movement of the palate. Nothing but 
liquid food is to be allowed, which should be 
swallowed with little effort, and coughing, spit- 
ting, sneezing must be prevented as much as 
possible. The stitches have to remain in ten or 
twelve days, more or less, as the case demands. 
The voice does not regain its natural tone and 
clearness for some time after the operation, and 
the child has to be instructed in the use and 
movements of the palate and tongue, for some 



CLEFT PALATE. 317 

time. Where the hard palate, or roof of the 
mouth, is fissured, the trouble is sometimes rem- 
edied by putting in plates of silver, gold, -ivory, 
or rubber. It can be remedied also by dissect- 
ing the tissues from about the arches of the 
palate and uniting them, the same as in fissured 
soft palate. There are various operations and 
methods of procedure for overcoming this de- 
formity, though not varying much in their 
essential points, and suffice it to say that they 
all generally result in perfect relief. 

Frequently the uvula, or that portion of the 
palate which is seen hanging from the roof of 
the mouth, is much larger than usual, requiring 
to be snipped off a little, for by dragging upon 
the tongue it keeps up a continual irritation, or 
tickling of the throat, provoking a troublesome, 
hacking cough. The tonsils also become fre- 
quently diseased and enlarged, which renders it 
necessary to remove the diseased portion, either 
by local applications of caustic preparations, or 
by the knife. The operation for their removal 
is simple, quickly performed, and gives rise to 
but little pain or inconvenience, if care is taken 
not to wound any blood vessels, so that hem- 
orrhage shall be avoided. 

27* 



HARE LIP. 



This deformity consists in a cleft or fissure, 
either single or double, under one or both nos- 
trils. The most common form is the single 
fissure, which extends through the upper lip, 
not infrequently exposing one or two teeth and 
the gum. Where the hare lip is double, there 
is generally deformity of the palate at the same 
time. It is recommended that this operation be 
performed very early in life, any time after two 
or three months old, and even earlier if the 
necessity for its performance exists. 

The essential points in the treatment of hare 
lip are as follows : 1st — To procure union by 
the direct adhesion of the cut edges of the fissure. 
2nd — That the union should be attended by as 
little deformity as possible. 3rd — the avoid- 
ance of all strain or traction on the fissure after 
it has been fastened together by pins or stitches. 



HARE LIP. 319 

These objects of treatment are secured by paring 
the edges of the fissure freely, bringing them 
together by means of twisted sutures, and re- 
moving the strain upon them by means of proper 
appliances. The operation is simple in its 
nature, readily performed, and causes but com- 
paratively little pain and inconvenience, and the 
cure of the deformity is complete. The full 
details of all the various methods of overcoming 
the deformity are not called for, and the rules 
to be enforced would always be laid clown after 
any and every operation, best suited to the indi- 
vidual case. People in middle life are frequently 
seen with this deformity, for which there can 
be no reasonable or pardonable excuse, and for 
their own sakes, as well as those with whom they 
are brought in contact, they should see to it 
that the unsightly malformation is corrected. 



CLOSURE OF THE LIPS, EYE-LIDS AND 
VULV.E. 



Although rare, yet it does occur, that the 
lips, eye-lids, and vulvas, or vaginal lips are 
grown together, and where these several adhe- 
sions exist, the trouble is overcome by thoroughly 
dividing the adherent surfaces, and keeping them 
well separated until the healing process is per- 
fected. Care needs to be exercised to see that 
the division is carried to a sufficient extent so 
that no deformity or contractions may remain 
afterwards. Frequently the adhesion of the 
vaginal lips is not discovered until menstruation 
takes place, when trouble arises, and on investi- 
gation it is ascertained that the menstrual fluids 
are retained in the womb and vagina, producing 
more or less pain, and distention of the organ. 
When such is the case the membrane has to be 
divided, the accumulated fluids drawn off, and 
healing, cleansing applications have to be made 






CLOSUKE OF THE LIPS, ETC. 321 

afterward. Parents should early look to it and 
see that no such deformities exist without their 
knowledge, and they are certainly remiss in duty 
if they allow them to go unremedied. 



IMPEDIMENTS OF SPEECH. 



The defects of speech known as stammering, 
or stuttering, have been ascribed to various 
causes, and various operations have been resorted 
to for the purpose of remedying the evil. It 
seems, however, the impediments of speech are 
largely owing to nervous causes, and the force 
of example. Children have often acquired the 
habit by going with another child in the habit 
of stammering, bringing on the trouble by fre- 
quent imitation. 

The impediment may also be congenital, and 
may result from nervous affections of various 
kinds. The several operations performed for 
the cure of these defects have been of little or 
no avail, and all that is accomplished generally 
is by a systematic course of instruction, and 
careful training, in which the child is made to 
talk slow, without being fretted or excited, 



. IMPEDIMENTS OF SPEECH. 323 

enunciating every word clearly, and not allowed 
to speak or talk when excited. All threats of 
punishment or disgrace, and everything tending 
to excite the emotions, and nervous system of 
the child, must be strictly guarded against. 
Children should not be sent to school who are 
thus afflicted, for they are so much embarrrassed 
that it is continual torture to them. A stam- 
mering pupil may understand his lesson as well 
as the best of scholars, but cannot give utter- 
ance to it, and so is ranked as a fool almost, and 
treated as such by the rest of the pupils, if not 
by the teacher. For these reasons the child 
should be instructed by those who have some 
natural sympathy for him, and will show him all 
due consideration and respect. 



STRABISMUS— CROSS EYES. 



Strabismus, or squint, according to the defi- 
nition of Mr. Holthouse, consists in a mal-direc- 
tion of one or both eyes, or a want of power to 
move them harmoniously, so that their axes 
shall always be directed at the same time to the 
same place. 

There are two kinds of strabismus ; one 
where the eye is drawn inward, and the other 
where it is drawn outward, but the variety in 
which the eye turns inward is the most common. 

Let any child with cross eye be directed to 
look upon an object placed a little distance be- 
fore him, the squinting eye will be found to turn 
inwards towards the nose, while the sound eye 
is directed to the object ; and it makes no dif- 
ference in whatever way the position of the 
object may be changed, the effect will be the 
same, the sound eye gazes at the object, while 



STKABISMUS CROSS EYES. 325 

the affected eye does not. Should the patient 
close the sound eye, he can then direct the other 
upon any object desired. Where the eye is 
turned outward, there is also want of harmony 
in the movements of the eyes, one being everted 
while the other is directed upon the object. 
Sometimes there is both divergent and converg- 
ent cross eyes, and also double convergent 
strabismus, in which case both eyes are habitu- 
ally turned inwards towards the nose. In most 
cases of cross eyes, vision is impaired to a greater 
or less degree, and frequently there is double 
vision. The distorted eye is, as a rule, more or 
less prominent, and the pupil of the cross eye 
does not respond naturally to the action of light. 

This deformity arises from a variety of causes. 
Sometimes it comes on after an attack of scarlet 
fever, measles, and the several eruptive diseases. 
At other times, or in other cases, it may be due 
to some weakness of the muscles, or paralysis of 
the nerves which control the movements of the 
eye-ball. Again it may arise from disease of the 
brain, or nervous centers ; from worms in the 
intestines, and from imitation children have 
acquired the deformity. Defective vision, con- 
vulsions in children, difficult teething, whooping 

28 



326 STRABISMUS — CROSS EYES. 

cough, epilepsy, injuries to the head, all are said 
to frequently give rise to cross eyes. The de- 
formity almost always develops quite early in 
life, and sometimes proves to be temporary, 
and owing to some simple functional disorder, 
while in the great majority of cases it continues 
until remedied by an operation. 

In cases where the deformity is due to some 
local inflammation of the eye, or to some func- 
tional derangement, sometimes the difficulty is 
overcome by proper attention to the general 
health, and relieving the local inflammation. 

The operation for the cure of cross eye con- 
sists in properly dividing the tendons of the 
muscles that produce the deformity. Thus : if 
the eye is drawn outward, the outer, or external 
rectus muscle must be divided ; and if the eye 
be drawn inward, the inner or internal rectus 
muscle is to be cut, and so on. The operation 
is quickly performed, causes little or no pain, 
the wound promptly heals, and the deformity is 
fully overcome. The real cause must first be 
ascertained, before seeking to remedy the de- 
formity, and this duty, together with deciding as 
to the propriety of an operation, and the proper 
time for its performance, you must leave for 



STRABISMUS CROSS EYES. 327 

your medical adviser to discharge. Your duty 
as parents is to see that the deformity is removed, 
for the sake of the future welfare of your 
children. 



CONGENITAL CATARACT. 



Cataract consists of an opacity of the crys- 
taline lens of the eye, or its capsule. Infants 
are frequently born with the disease, in which 
case both eyes are usually involved. Infants 
are very liable to attacks of inflammation of the 
eyes soon after birth, and it is after the subsid- 
ence of these inflammatory seizures, that the 
opacity, or cataract, is first discovered. Where 
the disease is congenital, it is said to be due to 
an original imperfect formation of the crystaline 
lens. When the opacity involves the entire lens 
the eye should be operated on before teething 
commences. Dr. W. Jones says : As the infant 
cannot see, its eyes are not fixed upon any 
object, but roll about in a heedless manner. 
This being allowed to go on the infant loses 
command over the eyes, or rather does not 



CONGENITAL CATARACT. 329 

acquire command over them ; and even if sight 
be afterward restored by an operation, the power 
of directing the eyes properly and steadily 
towards objects may never be fully gained. 
As a rule good sight is more likely to result 
from an early operation. 

There are many things to be taken into con- 
sideration in the management of all cases of 
cataract, as all operations should be performed 
under the most favorable conditions of the eye, 
and of the general health. There are different 
kinds of cataract, which call for different opera- 
tive procedures, which can only be determined 
by the oculist, or medical attendant. 

As there is no other remedy for the disease, 
parents should show no hesitancy in having an 
operation performed, for they are conferring the 
greatest possible favor to the child by thus 
restoring, or rather securing vision. The oper- 
ation is short, causes little suffering, and in the 
majority of cases renders vision very good if 
not perfect, after sufficient time has elapsed after 
the operation, wherein the child has acquired 
control and use of its eyes. Never let your 
children go blind five or six years with cataract, 
when relief is so promptly and surely to be 

28* 



330 



CONGENITAL CATARACT. 



obtained. The particulars of the proceedings 
in case of an operation for cataract, if detailed 
here would not be well understood, or compre- 
hended, therefore they will be omitted. 



STYES AND TUMORS OF THE EYE-LIDS. 



The eye-lids are subject to a variety of dis- 
eases, among which styes and tumors are fre- 
quent. A stye is a small swelling at or near 
the edge of the lid, which develops rapidly, and 
either soon disappears, or suppurates and dis- 
charges. If painful or troublesome they may 
be frequently bathed with a little lead and opium 
wash, or with a weak solution of acetic acid and 
tincture camphor. Tumors that so frequently 
grow in the substance of the eye-lids, consist of 
a small sack filled with a thick, waxy-like matter 
of the consistence of candied honey, or congealed 
lard. They continue to grow, though slowly, as 
long as they are allowed to remain. The oper- 
ation necessary for their removal consists in 
simply dividing the skin on the outside, or the 
mucous membrane on the inside of the eye-lid, 
and dissecting out the tumor and its enveloping 



332 STYES AND TUMORS OF THE EYE-LIDS. 

sack. It is not enough to simply empty the 
contents of the tumor, for if the sack is left it 
will fill again, and so the tumor or growth will 
reform. The operation is so simple, and at- 
tended with so little pain, that young children 
will sit still until the operation is completed and 
the trouble removed. There is nothing at all 
alarming about these simple, non-malignant 
growths in the eye-lids, but they somewhat dis- 
figure the child, and when of considerable size, 
they act as an irritant upon the surface of the 
eye, giving rise to more or less inflammation and 
disordered vision. They are usually seen in 
children whose digestive organs are debilitated, 
with feeble constitution, and general health more 
or less impaired, therefore a tonic strengthening 
course of treatment is called for after an opera- 
tion. Bark, wine and iron, together with a good 
nourishing diet, should be given, for some little 
time, in order to guard against future attacks. 



NEVUS, OR MOTHER'S MARK. 



There is a variety of malformations known as 
mother's mark, such as erectile tumors, vascular 
growth, and special deformities of one kind and 
another. That the foetus in utero is susceptible 
to impressions communicated through the ner- 
vous system of the mother, is well proven, and 
as a result of these nervous impressions the de- 
velopment of the child may become arrested, 
limbs spontaneously amputated, and various 
unsightly growths appear upon the surface of 
the body. Tumors of the veins are the most 
common mark that is noticed. At birth they 
are simple small red, or purplish spots, which 
continue to grow and spread, until they' acquire 
a considerable size, unless early attended to. 
Their removal is accomplished by tieing the 
tumor, strangulating it ; by passing needles 
through them or beneath them and then ligating, 



334 NEVUS, or mother's mark. 

or by the applications of caustics, as nitric acid, 
lunar caustic, &c. 

Oftentimes the trouble will disappear without 
any treatment, but where the blood tumor is of 
any considerable size it should receive early at- 
tention. Most of the malformations known as 
mother's marks are attributable to fright, imagi- 
nation, injuries, or some shock to the nervous 
system of the mother, received while carrying 
the child ; therefore pregnant women should 
guard against all undue excitement, physical and 
mental. Whatever the mark or deformity may 
be, if it is curable, let it be remedied as soon as 
possible and not wait ten or a dozen years. 



ATRESIA ANI, OR CLOSURE OF THE 
BOWEL. 



Not unfrequently infants are born with the 
anus, or opening into the bowels, completely 
closed, so that no movement of the bowels can 
be accomplished. The bowel usually terminates 
in a blind pouch a short distance from the natu- 
ral outlet. The difficulty is overcome by an 
operation, which consists in puncturing, or 
thoroughly dividing the intervening tissues, and 
thus establish communication with the intestine. 
The opening must be well kept open, by means 
of lint and proper appliances, until the parts are 
healed, and the artificial opening, or anus, has 
become permanent. If the attending physician 
fails to discover any trouble of this kind, the 
nurse should always carefully examine the infant, 
and promptly report the discovery of anything 
and everything that is unnatural, either in the 
anatomy, or general appearance of the infant, 
that it may receive early attention. 



UMBILICAL HERNIA, OR TUMOR OF 
THE NAVEL. 



This consists of a small tumor formed by the 
expansion of the umbilical cicatrix, the swelling 
or tumor being formed by the protrusion of a 
portion of the intestine, or the omentum, or 
layer of fatty tissue which covers it. The cause 
of the formation of this hernia, or navel tumor, 
may be either external or internal. It is some- 
times caused by the continual crying of the child 
in cases where the bowels are flatulent, or dis- 
tended with gas, and at other times it is caused 
by too tight bandaging, thus squeezing the con- 
tents of the abdomen up into too small a com- 
pass, and thereby forcing them into the umbili- 
cal cord. 

When infants are born with it, it is apt to be 
more extensive and serious in its nature. As a 
rule, the trouble is easily remedied by putting 
on a compress of rubber, steel, silver, or any 



UMBILICAL HERNIA. 337 

hard substance, so shaped that it can be nicely 
fitted, and when applied will keep the tumor 
pressed back into the abdomen. Too much 
pressure should not be applied, for it would add 
to the trouble by producing irritation, and sub- 
sequent inflammation. 

In the great majority of cases, these simple 
mechanical appliances will suffice, while there 
may be exceptional cases where some opera- 
tive procedure may be called for. Where there 
is ulceration of the cord, or navel, an ointment 
of zinc, or of benzoic acid and zinc with lard, 
or a little red precipitate ointment, should be 
applied once or twice daily, at the same time 
frequently cleanse the ulcerated surface with 
soap and water. 

29 



INGUINAL AND SCROTAL HERNIA, OR 
RUPTURE. 



It is generally the case, that the opening in 
the abdomen through which the testis, or pri- 
vate organs pass, closes soon after their passage 
down, but where the canal remains open, the 
bowel, or a portion of the intestine, passes down 
into it, causing rupture, or inguinal hernia, as 
it is called, and when the bowel passes down into 
the scrotum, or sack, enveloping the private 
organs, it is called scrotal hernia. This is a very 
frequent deformity of infancy, and should re- 
ceive prompt attention, for in early life a cure is 
much more easily effected, than in later life. 

The method of treatment is as follows : When 
there is positive evidence that the testicle has 
descended into the scrotal sack, the protruding 
portion of the bowel is to be returned into the 
belly, and retained therein by means of a prop- 
erly adjusted truss, the pressure of which causes 



INGUINAL AND SCROTAL HERNIA. 339 

slight inflammatory action, and closes the open- 
ing. At times there may be adhesions which 
render it impossible to reduce the rupture, and 
an operation in rare instances may be demanded. 
There are other varieties of rupture, all however, 
requiring about the same kind of treatment. 
All of these deformities or malformations of the 
intestinal region, urethra, or water passage, and 
of the rectum, should receive early and skillful 
attention, in order to avoid a life long burden 
and deformity, which renders existence a misery. 



PHYMOSIS. 



This malformation consists in an unnatural 
constriction of the prepuce, or fore-skin, cover- 
ing the glans penis, the constriction sometimes 
being so great as to interfere with the passage 
of the urine. Generally speaking, these narrow- 
ings of the preputial orifice, correct themselves 
as children grow older, but there are times when 
immediate relief is called for, which is best 
secured by means of the operation of circum- 
cision, which consists in slitting up the fore-skin 
sufficiently to let it back of the glans, and re- 
move thus all constriction of the organ ; or by 
means of a circular incision, removing a portion 
of the prepuce, and afterward stitching the cut 
edges of the skin and mucous membrane to- 
gether. The operation is simple, quickly per- 
formed, and affords immediate and permanent 
relief. 



CONTRACTION OF FINGERS. 



It sometimes happens that contraction of the 
muscles of the fingers and palm of the hand will 
become so severe as to give rise to what is known 
as club-hand, being similar to the deformity 
called club-foot. The muscles as they contract 
forcibly draw and flex the fingers into the palm 
of the hand, so that all efforts to extend, or 
straighten them are futile. 

The remedy consists in dividing, one after 
another, the tendons and muscles, and keeping 
them properly extended until the divided ten- 
dons and muscles become properly healed and 
attached. Contraction of the muscles of the 
neck often draws the head to one side, causing 
the deformity known as wry neck. 

29* 



CLUB FOOT. 



There are several varieties of this peculiar 
deformity, caused alike by rigidity and contrac- 
tion of various tendons and muscles. Children 
may be born with the deformity, or it may 
develop itself soon after birth, or at any other 
period of life. The following are the several 





Before Treatment. 



After Treatment. 



varieties noticed : Talipes equinus, in which the 
heel is elevated so that the patient walks on the 
ball of the foot ; talipes calcaneus, in which the 
front part of the foot is elevated, and the heel 



CLUB FOOT. 345 

depressed, so that the latter receives the weight 
of the body ; talipes varus, in which the foot is 




Before Treatment. After Treatment. 

inverted, so that the patient walks on the outer 
edge of the foot ; talipes valgus, in which the 



346 



CLUB FOOT. 



foot is everted, so that the patient walks on the 
inner ankle. Sometimes there are distortions 




Before Treatment. 



After Treatment. 



wherein two of these deformities are united in 



one. 



The 



exciting causes of this deformity 



CLUB FOOT. 



347 



when it comes on after birth is said to be any- 
thing that prevents the proper nutrition of the 




Before Treatment. After Treatment. 

muscles, or that interferes with their nervous 



influence. 



It also arises from wounds, inflam- 




liefore Treatment. 



After Treatment. 



mation, rheumatism, burns, paralysis, &c. It is 
also attributed by some to disease and irritation 
of the internal organs, and nervous centres. 



348 



CLUB FOOT. 



When the deformity is seen early, before the 
muscles and tendons have become firmly and 
rigidly contracted, it may at times be overcome 





Before Treatment. 



After Treatment. 



by the proper applications of gutta percha 
splints, bandages, &c, but as a general rule, the 
muscles and tendons that are contracted must 




Before Treatment. 



After Treatment. 



be divided, and afterward the foot be brought 
into its proper position by gradual, forcible 
extension and manipulation, the mechanical ap- 
pliances at the same time being so adjusted as to 
exert a continual force in the required direction. 



CLUB FOOT. 349 

As there is much better chance of completely 
overcoming the deformity when attended to 
early, parents should consult their medical ad- 
viser, or surgeon, as soon as the deformity is 
noticed. It is unnecessary to mention in detail 




Before Treatment. After Treatment. 

here the various steps of the operations required 
in the several varieties of club foot, as they do 
not vary much in kind, but suffice it to say, that 
they generally result in a removal of the un- 
sightly and ungainly deformity. 
30 



BOW LEGS AND KNOCK KNEE. 



These deformities are very common in infancy, 
and although unsightly enough then, they make 
people in maturer years to present a much more 
awkward appearance. 





Before Treatment. After Treatment. 

The malformation, or deformity, is generally 
caused by the infant being allowed to walk at 
too early an age, before the bones and muscles 
have acquired adequate strength for the support 
of the body. The weight of the upper extrem- 




GENU-VALGUM, OR BOW KNEE. 

Before Treatment. 



Page 350. 




GENU-VALGUM, OR BOW KNEE. 

After Treatment. 



Page 860. 



BOW LEGS AND KNOCK KNEE. 351 

ities being too great, the ligaments yield, the 
bones being flexible, bend either outward or 
inward as the case may be, and either bow leg 
or knock knee results. 





Before Treatment. After Treatment. 

Parents are very apt to let these deformities 
go unremedied, either thinking them of little 
importance, or incurable. 

Any parent who thus neglects a child, and 
allows it to grow up the object of pity, as well 
as an eye-sore to the public, never ought to be 
pardoned, as he will never be by his offspring. 



352 BOW LEGS AND KNOCK KNEE. 

As soon as the tendency to this deformity is 
known to exist, proper mechanical supports 
should at once be applied to the limbs, and suf- 
ficient tension maintained to keep them in their 
proper and natural position. By early attention 
to these rules the limbs, although sadly distorted, 
can generally be restored to their normal con- 
dition. 




Before Treatment. After Treatment. 

KNOCK KNEE. 

Page 352. 



HIP DISEASE. 



We come now to consider one of the most 
serious, and not uncommon, surgical diseases of 
childhood. It frequently comes on from very 
trivial causes, such as over exertion in too 
active exercise, taking too long walks, a sprain 
received in falling or jumping, getting wet and 
taking cold when in a state of perspiration. 
Hip disease may assume an acute, subacute, or 
chronic inflammatory character, and differ widely 
in its severity in different cases. Children of a 
scrofulous or strumous habit of body are much 
more liable to the affection than others. 

There is usually much pain in the diseased 
joint, sometimes suppuration, or discharge of 
matter, which continuing, disorganizes the joint, 
so that it becomes liable to dislocation, in which 
event the limb or joint becomes stiff and im- 
movable oftentimes. 

30* 



354 HIP DISEASE. 

The pain in hip disease varies according to 
the nature and extent of the inflammatory af- 
fection. In the chronic form of the disease it 
is at first comparatively slight, and often felt 
more at the knee than at the hip. In cases 
where the structure of the joint and socket are 
at once involved, the pain is quite severe, 
and every movement greatly aggravates it, on 
account of the inflamed condition of the mem- 
brane entering into the formation of the joint. 
Suppuration does not take place in all cases, 
but most frequently is seen in scrofulous patients. 
As the disease advances, and the socket and head 
of the thigh bone become diseased, and par- 
tially destroyed, the head of the bone becomes 
dislocated and thrown backward, so that the 
limb is shortened several inches. Abscesses 
often form in and around the joint before dislo- 
cation takes place, which cause a good deal of 
pain and constitutional disturbance. As the 
internal structures of the joint become involved 
the pain is intense, attended with spasms and 
twitchings of the limb. So great is the suffer- 
ing that the patient cannot bear the slightest 
movement, and cannot even tolerate the weight 
of the bed clothes, and the jar caused by a per- 




Before Treatment. 




After Treatment. 
HIP DISEASE. 



HIP DISEASE. 355 

son leaning against the bed, or walking across 
the room, will often cause great pain. 

The terminations of acute hip disease depend 
largely upon the constitution of the patient, and 
the methods of treatment resorted to. Some- 
times under exceedingly favorable circumstances 
a gradual recovery may take place with but 
little distortion and shortening of the limb, with 
but little stiffness and wasting of the limb. In 
other cases the patient may become completely 
exhausted by the continual and profuse dis- 
charges, and die from exhaustion. 

The deformities produced by the disease are 
contractions of the hip and knee, dislocation of 
the hip, with more or less shortening of the 
limb, and flattening of the buttocks, &c. 

A disease so severe in its nature, so rapid in 
development, so disastrous in its consequences, 
requires prompt and vigorous treatment. The 
strength of the patient is to be kept up by 
means of the most nutritious diet possible, this 
being rendered doubly important from the fact 
that it is usually weakly, strumous children that 
fall victims to this malady. 

External applications, either soothing or irri- 
tating as the case demands, are of more or less 
utility, and the internal administration of tonics 



356 HIP DISEASE. 

like iron, quinine, brandy, ammonia, bark, iodine, 
and kindred medicines are called for. The 
greatest benefit seems to be derived, however, 
by proper extension and counter extension of 
the limb, so as to separate the joint so that the 
inflamed surfaces of the socket, and head of the 
bone will not rub or press together. Various 
mechanical appliances have been arranged for 
this purpose, some of which are well adapted to 
the use intended, and afford great relief. All 
abscesses should be opened so as to allow free 
exit of pus, and absolute rest should be strictly 
enjoined. Where other means fail the operation 
of removing the head and a portion of the shaft 
of the thigh bone, is performed, and the dead 
or diseased portion of bone being thus removed, 
suppuration ceases, the wounds heal, and re- 
covery takes place, though with a limb compar- 
atively useless. The more prominent outlines 
of the disease have been here given, and some 
of the methods of treatment cited, but it is not 
required to go into full details in a work like 
this. 

Whenever a child manifests pain or uneasiness 
in walking, an examination should be made to 
see where and what the trouble is, and so be on 
the guard against the approach of this serious 




Before Treatment. After Treatment. 

DISLOCATION OF HIP JOINT FROM PARALYSIS. 

Page 356. 



HIP DISEASE. 357 

affection, and if not clearly and readily under- 
stood by the parents and friends, a medical 
adviser should be summoned without much 
delay, for true it is that time is precious in 
these cases. 



BONE DISEASES. 



The bony structures, like soft tissues, are 
subject to ulcerative and destructive diseases. 
Disease attacking the outer surface of the bone 
causes it to scale off, giving rise to ulceration of 
the soft tissues, and thus the way is prepared 
for the discharge of the scales of bone thrown 
off. When the bone becomes diseased on its 
inner surface, the whole bone is apt to die, and 
when it does it causes profuse suppuration, and 
discharge of offensive matter until the diseased 
bone is destroyed. During the inflammatory 
and suppurative stage of bone disease, new 
bone gradually forms around the dead bone, so 
that the strength and contour of the limb is 
maintained. The diseased limb is often consid- 
erably increased in size, by the extensive de- 
posit of new bone around the old. 

Diseases of bone are very common in chil- 



BONE DISEASES. 359 

dren, and while suppuration is going on greatly 
reduces and exhausts the flesh and strength of 
the patient. The weaker the constitution of 
the child, and especially if the child be of a 
strumous or scrofulous habit of body, the greater 
the liability to this class of diseases. 

To remedy the bone affections the first duty 
is to look after the general health of the patient, 
see that proper nutrition of the body is secured, 
digestion is properly carried on, and the general 
sanitary conditions are what they should be. 
Where there is carious disease of the bones, or 
disease of the external surface, a cure can be 
promptly effected by cutting down to the 
diseased surface, and thoroughly and completely 
removing all unsound portions of bone. When 
the disease attacks the inner surface of bone, 
and the bone dies, then a cure is only accom- 
plished by entirely removing the section of dead 
bone. After this is done, granulation takes 
place, new bone is gradually formed, discharges 
soon cease, and the bone and limb regain their 
former health and strength. 

When the bones become thus diseased the 
trouble should not be allowed to continue with 
the expectation that a spontaneous cure will 



360 BONE DISEASES. 

take place, but it should receive immediate and 
careful attention, in order that the difficulty may 
be removed before there is a possibility of its 
becoming incurable. 



DISEASE OF GLANDS. 



Children who inhabit houses situated in low, 
damp places, and are poorly fed, ill nourished, 
exposed but little to pure air and sunlight, are 
above all others subject to glandular diseases. 

The glands most frequently involved in disease 
are the glands about the throat, under the arm 
and in the groins. They often swell up to a 
great size, and finally ulcerate and give rise to 
profuse suppuration, and ultimate destruction of 
the glands. 

Children thus affected are apt to be of a scrof- 
ulous habit of constitution, skin pale, flesh flabby, 
and the countenance wears a look of weariness 
and impaired vitality. 

To remedy these evils of constitution, or what 
is better, prevent them, give children the full 
benefit of abundant airing and exercise out of 
doors, in places exposed to the full rays of the 

31 



362 DISEASES OF GLANDS. 

sun ; see that abundant and proper nutriment is 
furnished, and if they chance to be predisposed 
to scrofulous affections, or other vices of consti- 
tution, administer iron, iodine, and vegetable 
tonics ; pay proper attention to clothing, and 
regulate it according to the temperature, and 
bathe frequently in acid, salt, or mustard baths, 
in order to secure healthy and active cutaneous 
circulation. 

It must be remembered that these glandular 
affections, if not early attended to, lead on to 
other diseases that are more serious and fatal in 
their consequences. 



POLYPI. 



These growths are pendulous, usually pear- 
shaped masses, growing from the mucous sur- 
faces, especially from the nose, ear, throat, 
uterus and anus. In children they most fre- 
quently affect the nose, throat and ears. Any- 
thing that irritates and inflames the mucous 
membranes may give rise to them, such 
as long continued catarrhal troubles, inflam- 
mation and suppuration following measles and 
scarlet fever. They generally are attached 
by a small root, and hang down into the ante- 
rior or posterior nostrils, interfering with breath- 
ing, and when seated in the canal of the ear so 
obstruct it as to cause more or less deafness. 
The only remedy for these growths is the re- 
moval of them With the knife or forceps, and 
caustic applications to kill the roots of the tu- 
mor, so as to prevent their recurrence. 



ENLARGEMENT OF THE TONSILS. 



The tonsils frequently become considerably- 
enlarged, as a result of inflammation, or the dif- 
ficulty may arise without any assignable cause. 
Where the enlargement is extensive the glands 
obstruct the posterior nares, render the voice 
thick, cause deafness, cough, and more or less 
difficulty in breathing. 

Strong solutions of nitrate of silver, say one 
drachm to the ounce, applied with a brush to 
the tonsils, or tincture of iodine, will gradually 
bring down the swelling. External applications 
of tincture of iodine, and stimulating liniments, 
will be useful adjuncts to the internal treatment. 

In cases where these local and external appli- 
cations do not remove the trouble, the knife 
must be had recourse to, and a portion of the 
tonsils be removed. 



RANULA, OR TUMOR UNDER THE 
TONGUE. 



This consists of a tumor, globular in form, 
and is said to be owing to obstruction of one of 
the salivary ducts, and becomes filled with a 
semi-transparent fluid like saliva. It sometimes 
grows to considerable size, pushes up the base 
or roots of the tongue, and interferes with the 
act of swallowing. 

Sometimes the growth is of the form of an 
encysted tumor, which attains to the size of an 
orange. Generally, however, the growth is 
small, but might grow to a greater size if 
allowed to progress. 

The tumor is to be removed either by caustic 
applications, by passing a seton through it, or 
by the knife. The affection we are glad to say 
is rare, but when it is noticed, it should not be 
neglected, though the child be ever so young. 

31* 



FOREIGN BODIES IN THE EARS AND 
AIR PASSAGES. 



Children as soon as they can creep, and es- 
pecially walk about, are continually picking up 
substances that come within their grasp, and 
forcing them into the ears, nose and mouth, fre- 
quently swallowing them, producing violent 
choking and coughing. The substances most 
frequently disposed of in this way are buttons, 
peas, beans, stones, pins, marbles, beads, bits 
of slate pencils and nails. Children will often 
force things up the nose and into the ears, out 
of sight, and any attempt of the parents or 
friends to remove them generally is unsuccessful, 
and only serves to irritate the parts, and push 
the substance further into the opening. Often- 
times they become firmly impacted in the pas- 
sages, the mucous membrane becomes swollen 
around them, when it is no easy task to remove 
them, especially if the substance happens to be 



FOREIGN BODIES IN THE EAR, ETC. 367 

a bean, smooth button, or anything with a 
smooth, hard surface. 

When the foreign substance is pushed high 
up into the nostrils, and cannot be readily got 
hold of, it is sometimes advisable to push it 
backward into the throat, taking care that the 
child does not swallow it, and get choked. Gen- 
erally, the substance can be reached and grasped 
with forceps, and removed without much diffi- 
culty, provided the patient can be kept in one 
position long enough to accomplish the object. 
Sometimes the articles can be syringed out of 
the nose and ears, if they , are not pressed 
tightly in. 

As a rule, it is unwise for parents or friends 
to attempt to remove substances from the ears 
and nostrils, for they will be liable to produce a 
good deal of irritation by the force used, and 
they being sensitive organs cannot tolerate 
too much manipulation without serious injury. 
If it is decided to call a physician, do not wait 
until the object you wished removed becomes 
obscured by inflammation and swelling of the 
tissues around it. Where the foreign body gets 
into the throat, and is choking the child, give 
a prompt emetic, and force it up if possible. 
Sometimes it can be forced downward, by means 



368 FOREIGN BODIES IN THE EAR, ETC. 

of tubes introduced into the throat. If the 
substance is small, drinking freely will some- 
times remove it, or swallowing oil, or glycerine, 
being heavier and of more consistence, will be 
more likely to accomplish relief. 

There are various instruments designed for 
physicians' use, with which various foreign 
bodies can be easily removed, but which would 
not be safe to use in domestic practice, by un- 
educated hands. 



BURNS AND SCALDS. 



These are among the most frequent accidents 
that befall children, hence they should receive 
more than a passing notice. The general and 
constitutional effects of a burn or scald depend 
upon their extent and location, and the vital 
strength of the patient. If the burn is exten- 
sive the shock to the nervous system is propor- 
tionally great. In ordinary burns the skin and 
superficial tissues are only involved, producing 
vesication, and a discharge of serum, while in 
the more extensive burns the deeper tissues are 
involved, ulceration and sloughing takes place, 
and profuse suppuration follows, and when the 
parts heals cicatrices form, producing unsightly 
contractions and deformities. 

Where the burn is severe the patient may die 
from the shock to the nervous system, but if the 
patient survives this, the pain may give rise to 



370 BURNS AND SCALDS. 

dangerous congestion of the vital organs, by 
exciting the heart, brain, and spinal cord. 
After the patient rallies from the nervous shock, 
and reaction takes place, there is more or less 
fever, which continues to a greater or less 
degree, through the stage of reaction and sup- 
puration. 

The first object to be accomplished in the 
treatment of a burn is, to relieve the intense 
pain and depression, and for this purpose opium 
in some one of its forms may be given, and 
chloroform has been used where the pain is 
severe. A thousand local applications have 
been extolled, such as flour, starch, cotton wad- 
ding, solution of India rubber, and the like, 
but it matters not so much what the article is 
that is used, provided it protects the parts from 
the air. A common domestic remedy is flour 
sprinkled evenly on the burned surface, so as to 
protect from the air, and it answers the purpose 
very well for all ordinary burns. Solutions of 
gun cotton, or collodion, and gutta percha, also 
answer the same purpose, though they cause 
some smarting when first applied. Carron oil, 
composed of equal parts of lime water and lin- 
seed oil, is a useful application, and should be 
applied by means of lint, or cloths thoroughly 



BURNS AND SCALDS. 371 

saturated with the compound. . A solution of 
carbolic acid in glycerine is an excellent appli- 
cation, and a solution of opium, tannin and 
glycerine also affords relief. Deep ulcerations 
and exuberant granulations frequently form, 
which require the application of ointments, such 
as the red precipitate, lead, and citrine, and strong 
solutions of nitrate of silver, or tincture of 
iodine. Care must be exercised to see that 
sympathetic inflammation and congestion of the 
internal organs does not take place, as they are 
very liable to in severe burns and scalds. Great 
care must also be taken to guard against mus- 
cular and tendinous contractions; as the injured 
parts are healing. 



WEAK ANKLES. 



It is frequently the case that children who 
are old enough, cannot walk on account of weak 
ankles. The muscles and tendons are relaxed, 
and are not tense enough to give strength and 
solidity to the joint, so that if the child attempts 
to walk the feet turn over to one side or the 
other, generally outwards. 

Sometimes the trouble is quite persistent, and 
even in some cases permanent, if not properly 
treated. No child thus affected should be al- 
lowed to bear its weight upon its limbs unless 
some mechanical appliances have been fitted to 
the parts so as to furnish the needed support. 

There are splints made of steel plates extend- 
ing clown, and bands of the same encircling the 
limbs, which if nicely adjusted, and worn for a 
sufficient length of time, will entirely remedy 
the difficulty. Occasionally more or less of the 



WEAK ANKLES. 373 

trouble arises from paralysis of the muscles, 
when means for strengthening them, and over- 
coming the paralysis will be required, such as 
frequent bathing in mustard water, and thorough 
frictions, applications of electricity, and stimu- 
lating lotions. 

All splints and mechanical appliances required 
for this and other surgical diseases, can be 
obtained at instrument makers, by forwarding 
the necessary measurements of the limb. As a 
rule it will be best to leave these important 
matters with the medical attendant, as he alone 
can attend to the case properly. 

32 



DIET IN HEALTH. 

PROM BIRTH TO SIX MONTHS OLD 
DIET 1. 

If the child be nursed and the breast milk be 
found in all respects suitable, no other food will 
be required. 

The child should take the breast alternately 
every two hours for the first six weeks, after- 
wards every three hours, except between 11 P. 
M. and 5 or 6 A. M. In cases where the secre- 
tion of breast milk is tardy, and insufficient in 
quantity, the following food in addition to the 
breast milk may be given : one tablespoonful of 
fresh cream, two tablespoonfuls of whey, two 
tablespoonfuls of hot water. This mixture is to 
be taken from a feeding bottle. The whey is 
made fresh in the house by adding one teaspoon- 



DIET IN HEALTH. 375 

ful of prepared rennet to a pint of new milk. 
After the milk is coagulated it is to be strained 
through muslin. 

DIET 2. 

If the infant be brought up b}>- hand, new milk 
and lime water in equal proportions, may be 
given. Three to four ounces, sweetened with a 
teaspoonful of sugar of milk, are to be given at 
first, every two hours, from a feeding bottle. 
The proportions of milk and lime water are to 
be varied according to the age of the infant. 
From six weeks to three months, one-third lime 
water may be used ; and from three to five 
months, this quantity should be reduced to one- 
fourth. 

DIET 3. 

If the infant be partially nursed, the breast 
milk being poor and scanty, the breast must not 
be given but twice daily. For the other meals, 
the child must be fed upon milk and lime water 
as directed in diet table No. 2. Up to the age 
of six months the milk should be warmed by 
dipping the bottle containing it into hot water. 
After the age of six months it may be boiled if 
convenient. New unskimmed milk should always 



376 DIET IN HEALTH. 

be used. In all cases where children are arti- 
ficially fed, great attention must be paid to the 
cleanliness of the feeding bottle. 

DIET 4. 

FEOM SIX TO TWELVE MONTHS OLD. FIVE 

MEALS IN THE DAY. 

First meal, 7 A. M. — One teaspoonful of 
baked or boiled flour carefully prepared with a 
teacupful of milk. 

Second meal, 10.30, A. M. 

Third meal, 2 P. M. — A cupful of milk ren- 
dered alkaline by half a teaspoonful or more of 
lime water. 

Fourth meal, 5.30 P. M. — Same as the first. 

Fifth meal, 11 P. M. — Alkaline milk as before. 
For the second meal a yolk of an egg, beaten 
up with a cup of milk, may occasionally be given. 

DIET 5. 
FOR A CHILD TEN MONTHS OLD. 

First meal, 7 A. M. — A tablespoonful of pearl 
barley jelly, dissolved in a cup of milk, and 
sweetened with loaf sugar. 

Second meal, 10.30 A. M. — A breakfast cup 
of milk and lime water. 



DIET IN HEALTH. 377 

Third meal, 2 P. M.— The yolk of one egg 
beaten up in a teacupful of milk. 

Fourth meal, 5.30 P. M. — Same as the first. 

Fifth meal, 11 P. M. — Same as the second. 

Pearl barley boiled for six hours forms, on 
cooling, after the water is strained off, a jelly 
which dissolves readily in warm milk. 

DIET 6. 
(To alternate with the preceding.) 

First meal, 7 A. M. — Half a teaspoonful of 
cocoa essence, boiled for one or two minutes in 
a cupful of milk. 

Second meal, 10.30 A. M. — A cupful of milk 
and lime water. 

Third meal, 2 P. M.— A cupful of beef tea, 
(half a pound of meat to a pint of water.) 

Fourth meal, 5.30 P. M. — A spoonful of pearl 
barley jelly, dissolved in a cupful of milk, and 
sweetened. 

Fifth meal, 11 P. M. — Same as the second. 

If the child requires food before 7 A. M., on 
waking from sleep, a little milk may be given. 
A healthy child, between ten and twelve months 
old, will require from a pint and a half to a 
quart of milk in the twenty-four hours 

32* 



378 DIET IN HEALTH. 

DIET 7. 
FROM TWELVE TO EIGHTEEN MONTHS OLD. 

First meal, 7.30 A. M. — A slice of stale bread 
well soaked in a cupful of milk. 

Second meal, 11 A. M. — A drink of milk, a 
plain biscuit, or slice of thin bread and butter. 

Third meal, 1.30 P. M.— A cupful of beef tea, 
(a pound of meat to the pint,) a spoonful of 
some light pudding. 

Fourth meal, 6 P. M. — Same as the first. 

Fifth meal, 11 P. M. (if required.)— A drink 
of milk. 

DIET 8. 

(To alternate with the preceding.) 

First meal, 7.30 A. M.— The yolk of a soft 
boiled egg, a slice of bread and butter, a cupful 
of new milk. 

Second meal, 11 A. M. — A drink of milk, a 
slice of bread and butter. 

Third meal, 1.30 P. M. — A potato well mashed, 
moistened with two tablespoonfuls of good beef 
essence, or gravy, a cupful of new milk. 

Fourth meal, 6 P. M. — A slice of stale bread, 
well soaked in a cupful of milk. Many children 
between twelve and eighteen months old, will be 



DIET IN HEALTH. 379 

found to do well upon only three meals a day, 
as follows : 

DIET 9. 

First meal, 8 A. M. — One teaspoonful of 
baked or boiled flour, one teaspoonful of fine oat 
meal, one-half to three-quarters of a pint of 
fresh milk, a little white sugar. 

Second meal, 1 P. M. — The same with the 
addition of a yolk of one egg. 

Third meal, 5 P. M. — Same as the first. 

In this diet the flour and oat meal are first 
beaten up till smooth with four tablespoonfuls 
of cold water, and are then boiled. The milk 
and sugar are then added, and the mixture is 
boiled till it thickens. For the second meal the 
yolk is stirred up in the saucepan and boiled 
with the rest. 

DIET 10. 
FROM EIGHTEEN MONTHS TO TWO TEARS OLD. 

First meal, 7.30 A. M.— A cupful of milk, a 
little rice, or a slice of stale bread. 

Second meal, 11 A. M. — A cup of milk. 

Third meal 1.30 P. M.— Roast mutton or beef, 
done rare, pounded, or cut fine, a tablespoonful, 



380 DIET IN HEALTH. 

one well mashed potato moistened with beef 
essence. For drink, milk, or toast water, crust 
coffee. 

Fourth meal, 6 P. M. — A cup of milk, bread 
and butter. After the age of eighteen months 
old it is well to omit the meal at 11 P. M., for a 
healthy child of that age should sleep from 6 P. 
M. to 6 A. M. without waking. 

DIET 11. 

(For a child of the same age.) 

First meal, 7.30 A. M. — A cup of new milk, 
soft boiled yolk of one egg, a slice of bread and 
butter. 

Second meal, 11 A. M. — A cup of milk. 

Third meal, 1.30 P. M.— A cup of beef tea, a 
cup of plain custard pudding. 

Fourth meal, 6 P. M. — A cup of milk, bread 
and butter. These diets can be given on alter- 
nate da}'s. Between the ages of two and three 
years the same diets may be continued. Meat 
can, however, be given every day, and a little 
stewed fruit may be added. 



DIET IN DISEASE. 



For a child of two or three months old, brought 
up by hand, weakly and emaciated, in whom 
milk with lime water excites griping and flatu- 
lent colic, with occasional attacks of vomiting 
and purging. 

In these cases we can often succeed in render- 
ing the milk and lime water digestible by adding 
an aromatic. Thus, to half a pint of cold milk, 
add a teaspoonful of caraway seeds, or chopped 
cinnamon enclosed in a small muslin bag, and 
boil for five minutes. The bag is then with- 
drawn, and the lime water and sugar are after- 
wards added as usual. If this do not succeed, 
one of the diets given below can be tried. 



382 DIET IN DISEASE 



DIET 12. 

The child is to be fed every three hours from 
a feeding bottle, with the following, in alternate 
meals : 

1st. One teacupful of Liebig's food for infants 
dissolved in a cupful of new milk and water, 
(equal parts,) with the addition of atablespoon- 
ful of cinnamon, or caraway water. 

2nd. A cup of fresh whey, containing a tea- 
spoonful of cream. If the amount of milk given 
above cannot be digested, as is often the case, 
the proportion of water used to dilute the milk 
may be increased to two-thirds ; or in some of 
the meals the milk may be entirely omitted, 
using instead barley water, or equal parts of 
barley water and weak chicken broth in which 
Liebig's food can be dissolved. 



DIET IN CHRONIC DIARRHEA. 



For a child of twelve months old, who can hear 
milk, 'purging not severe. 

DIET 14. 
A teaspoonful of Liebig's food for infants, 
every three hours, dissolved alternately in milk 
and water (equal parts,) and in equal parts of 
mutton broth and barley water. If no milk at 
all can be digested, a good diet is the following : 

DIET 15. 

First meal, 7 A M. — One teaspoonful of Lie- 
big's food for infants, dissolved in a teacupful of 
mutton broth and barley water (equal parts.) 

Second meal, 11 A. M. — One tablespoonful of 
cream in a cupful of fresh whey. 

Third meal, 2 P. M. — Yolk of one egg beaten 
up with fifteen drops of brandy, a tablespoonful 
of cinnamon water, and a little white sugar. 



384 DIET IN CHRONIC DIARRHEA. 

Fourth meal, 5 P. M. — Six ounces of beef tea 
(a pound to the pint.) 

Fifth meal, 11 P. M.— Same as the first. 

DIET 16. 
FOR A WEAKLY CHILD OF TWELVE MONTHS OLD. 

First meal, 7 A. M. — Four ounces of whey, 
with a teaspoonful of cream. 

Second meal, 9.30 A. M. — Four ounces of 
veal or mutton broth, (half a pound to the pint.) 

Third meal, at noon. — A teaspoonful of pearl 
barley jelly, dissolved in four ounces of whey. 

Fourth meal, 2.30 P. M. — Four ounces of 
milk and lime water, (equal parts), with a table- 
spoonful of cinnamon water. 

Fifth meal, 5 P. M. — One teaspoonful of Lie- 
beg's food for infants, dissolved in four ounces 
of barley water. 

Sixth meal, 9 P. M. — Same as the second. 
During the night, whey or barley water may 
be given. 

If the purging be very severe, all regular 
meals should be discontinued, and the child be 
supplied with any of the above foods in quanti- 
ties of one tablespoonful every quarter of an 
hour. Diet 13 will often succeed in these cases. 



DIET IN CHRONIC VOMITING. 



Ik this disorder the food must be given in 
minute quantities, one teaspoonful in many cases 
being all that can be retained at one time. This 
may be repeated every ten minutes. 

Choice may be made from the following : Di- 
luted whey with cream as in diet 1 ; milk and 
lime water with cinnamon water ; one teaspoon- 
ful of Liebig's food for infants dissolved in four 
ounces of milk and water (equal parts,) or in 
equal parts of weak mutton broth and barley 
water. Whatever food is given it should be 
given cold or hot, not tepid. 

33 



DIET IN RICKETS. 



Here the kind of diet will depend in a great 
measure upon the condition of the alimentary 
canal. In almost all cases it will be found that 
farinaceous food has been supplied in excessive 
quantities, and the amount will have to be con- 
siderably reduced. If the bowels are relaxed, 
with loose, slimy, offensive motions, diets 1 5 and 
16 will be suitable. If the motions are healthy, 
diets 5, 6, 7, 8, 10, 11, may be made use of, 
according to the age of the child. 



DIET IN MUCOUS DISEASE. 



FOR A CHILD SEVEN OR MORE TEARS OF AGE. 
DIET 19. 

Breakfast, 8 A. M. — Three-quarters of a pint 
of milk rendered alkaline by the addition of 
lime water, a thin slice of toasted bread. 

Dinner at 12. — A small mutton chop broiled, a 
little well boiled spinach, or beans, according to 
season, a thin slice of toasted bread, a wine glass 
of sherry diluted with twice its bulk of water. 

Tea, 4 P. M.— Same as breakfast. 

Supper, 7 P. M.— A cupful of beef tea. 

Two of the meals should consist of milk. For 
the other meals selection should be made from 
the following : 

Meats : Roast beef, roast or boiled mutton, 
roast or boiled fowl. No spiced or salted or pre- 
served meats can be allowed. Fish : boiled cod, 



388 diet m MUCOUS DISEASE. 

turbot, mackerel, raw oysters. Eggs : Boiled or 
poached. Soup : Clear turtle, beef or veal tea. 
Vegetables : Cauliflower, spinach, turnip greens, 
asparagus, lettuce or celery (stewed.) For 
drink : Sherry or claret diluted with water, light 
bitter ale, toast water, milk and water. 



DIET IN TUBERCULAR DISEASE, AND IN 
CONSUMPTION. 



In these cases all fat forming material is of 
value, but as digestion is more or less impaired, 
in regulating the diet attention must be naid to 
this fact. 

FOR A CHILD SEVEN TEARS OF AGE. 
DIET 20. 

Breakfast, 8 A. M. — Half a pint of new milk 
to which lime water is added, a soft boiled egg, 
thin bread and butter. 

Dinner, 12 or 1 P. M. — A slice of roast beef 
or mutton with dressing, a mealy potato well 
mashed, milky farinaceous pudding. For drink, 
half a wine glass of sherry, diluted with twice 
its bulk of water. 

Tea, 4 or 5 P. M. — A teaspoonful of chocolate 

33* 



390 DIET IN" TUBERCULAR DISEASE. 

or cocoa boiled with half a pint of milk, bread 
and butter. 

Supper, 7 or 8 P. M. — Half a dozen raw oys- 
ters, or cooked if preferred, bread and butter. 
DIET 21. 
(For same age.) 

Breakfast, 8 A. M. — Bread and milk. 

Dinner, at 12 or 1 P. M. — Roast, or boiled 
fowl, a mealy potato, sherry and water ; for des- 
sert a bunch of sweet grapes. 

Tea, 4 or 5 P. M. — A soft boiled egg, bread 
and butter, half a pint of milk, or an egg may 
be beaten up raw with the milk. 

Supper, 7 or 8 P. M. — A cup of strong beef 
tea. 



HOW TO PREPARE BEEF TEA. 



Put half a pound or a pound of beef (accord- 
ing to strength required,) cut up into small 
pieces, into a covered sauce-pan, or into a bottle, 
with one pint of water. Let this stand by the 
side of the fire for four or five hours, and let it 
then simmer gently for two hours, season with 
salt, skim well, and serve. 

The meat should be used as fresh as possible, 
and should be cleared beforehand of all fat or 
gristle. If this precaution be neglected, a 
greasy taste is given to the beef tea, which can- 
not be removed afterwards by skimming. The 
sauce-pan should be made of copper or tin. 
Iron sauce-pans should not be used unless enam- 
elled. In re warming beef tea which has been 
left to cool, care must be taken to warm the tea 
up to the point at which it is to be served, and 
no higher. It should on no account be allowed 
to boil. 



CHEMICAL AND VEGETABLE DIET. 



Liebig's prepared food for infants, and Liebig's 
extract of beef, can be obtained at nearly all 
drug stores, and full directions for their use ac- 
company each package. 

Boiled rice, canna farina, pearl tapioca, sago, 
oat meal, and articles of this kind are suitable 
diet for children when in usual health. 

Many of the ripe fruits, in their proper season, 
may be allowed in the diet of children, but all 
unripe fruit and vegetables should be discarded, 
especially during the hot months. 



Note. — The photographs of club feet were kindly furnished by 
Buckminster Brown, M. D., of Boston, from cases occurring in 
his practice. 



SPLINTS AND MECHANICAL APPLIANCES. 



[For the benefit of all those who may have occasion to procure 
mechanical supports and various splints to use in overcoming de- 
formities, the following description of the more important and use- 
ful ones is giren, so that their use may be the better understood. 
They are manufactured by Messrs. Leach & Greene, of Boston, 
where they can always be obtained, or where one can get them 
made to order, in the highest style of the art.] 

No. 1 is a support for weak ankles. 
It consists of a steel foot piece riv- 
eted to the sole of the shoe with 
steel uprights, jointed at the ankle 
to correspond with the natural artic- 
ulation, and extending up each side 
of the leg to the calf, around which 
>they are buckled by a softly padded 
band. A cushioned pad inside the upright, be- 
low the ankle joint, supports the ankle on the 
side to which it is inclined to yield. A loose 
strap passing around the ankle and buckling to 
the opposite standard relieves the foot from 
undue pressure upon the pad. 




394 SPLINTS AND MECHANICAL APPLIANCES 



No. 2 is the Apparatus for bow legs. It con- 
sists of two steel uprights riveted to the sole of 
a strong laced boot, jointed at ankle and knee, 
with padded bands encircling thigh and calf. 
Cushioned pads inside the inner upright at 
knee and ankle joints afford points of resis- 
tance at either end of the curved bone. From 
the center of the inner upright an elastic strap 
passes around the leg over the arc of curva- 
ture, and when tightly drawn necessarily re- 
duces the curve. 



SPLINTS AKD MECIIAXICAL APPLIANCES. 395 




No. 3 represents the modification of Scarpas 
Shoe commonly used in the treatment of Club 
Foot. It consists of jointed uprights, similar to 
those in the Bow Leg Apparatus, which are at- 
tached to a padded metal shoe, jointed at the 
medio-tarsal articulation, so as to admit of lat- 
eral motion. Midway between the ankle and 
sole a strong steel is attached to the outer 
standard, and projects forward as far as the 
little toe joint. At the end of this spring is a 
strap, which passing around the shoe everts the 
foot on being tightened. The heel is kept down 
by a strap over the instep, which passes through 
two holes in the heel of the shoe, and ties be- 
hind. A strap passing from the toe of the shoe 
to the band below the knee raises the toe and 
stretches the heel cord. 



396 SPLINTS AND MECHANICAL APPLIANCES. 




No. 4 is Sayres' Club Foot Shoe, which has 
the same perpendicular supports as the others. 
The shoe is made like an ordinary laced boot 
with a metal inner sole, but is cut into at the 
Medio-tarsal articulation, and joined together by 
a ball and socket joint, which admits of free 
motion in every direction. On either side the 
shoe opposite the toe joints are metal hooks, to 
which are attached two elastic cords of rubber 
tubing, the shorter of which attaches to a knob 
on the heel of the shoe and moves the foot lat- 
erally, the longer attaches to the standard just 
below the knee and Ilexes and rotates the foot. 
The advantage of this form of apparatus over 
other styles is, first, greater control over the 
foot; second, the artificial rubber muscles allow 
the exercise of the weakened muscles of the leg, 
by which their power is increased rather than 
weakened. 



SPLINTS AND MECHANICAL APPLIANCES. 397 




No. 5 is an Apparatus for Knock Knees, con- 
sisting of two steel uprights attached to the sole 
of the shoe, and passing up the outer aspect of 
the leg — jointed at ankle, knee and hip, and at- 
taching tj a hand encircling the pelvis. Elastic 
hands are brought around the knee, crossing each 
other from below and above. By tightening 
those bands the knees are drawn outward, thus 
correcting the deformity. 



398 SPLINTS AND MECHANICAL APPLIANCES. 




No. 6 is Sayres' short splint for Disease of the 
Hip Joint. The lower portion of the Splint is 
attached to the thigh by adhesive plaster. The 
upper part, which plays in a ball and socket joint 
on a pad resting over the outer surface of the 
hip, is kept in place by a well stuffed perineal 
strap. Extension is effected by a ratchet move- 
ment, which is operated by a key. 



SPLINTS AND MECHANICAL APPLIANCES. 399 




No. 7 is a modification of Sayre's Long Splint, 
and obviates the necessity of using adhesive 
plaster. The foot piece of the splint is riveted 
to the sole of a laced boot. The uprights, which 
extend up either side of the leg, are retained in 
place by stuffed bands encircling the calf and 
thigh. The outer upright ends in a pad with 
ball and socket joint, like that on the short splint, 
and is held securely in place by a belt encircling 
the pelvis, and a perineal strap. Extension is 
effected by means of a nut and screw — the laced 
boot and the perineal strap affording the points 
of counter-extension. 



400 SPLIXTS AXD MECIIAXICAL APPLIAXCES. 




No- 8 represents Dr. Taylor's apparatus for 
angular curvature of the spine. It consists ot 
a metal band passing across the hips. From the 
center of this band two steel uprights extend up 
each side of the spine, and are connected at the 
top by a steel cross-piece at either end of which 
is an arm resting on the shoulder blade. A 
knob at each end of these arms affords attach- 
ment for padded straps, which pass over the 
shoulders and around the arms. The steel up- 
rights have a joint opposite the point of curva- 
ture, which opens backward, allowing of motion 
in that direction, but no other. Softly stuffed 
pads fitted so as to press evenly on the trans- 



SPLIXTS AXD MECHANICAL APPLIANCES. 401 



verse processes of the diseased vertebrae are 
placed under the jointed uprights, and by means 
of set screws the pressure can be increased 
either above or below as may be desired. A 
broad apron of firm drilling, covering the front 
of the body and buckling to the pelvic band and 
uprights, holds the apparatus in place, and with 
the shoulder straps keeps the spine erect, and 
has the effect of a splint upon a broken limb. 
This, like all spinal apparatus, requires very accu- 
rate adjustment to render it effective. 




No. 9 represents Leach & Greene's apparatus 
for Angular Curvature of the spine. It has the 
34* 



402 SPLINTS AND MECHANICAL APPLIANCES. 

pelvic band, apron, and steel uprights, the same 
as the Taylor apparatus, but the uprights are not 
jointed, but padded their whole length, and 
capable of being moulded so as to bring the 
pressure wherever it is required. It also has 
crutches which relieve the diseased vertebrae 
from sudden jars, and obviate the tendency to 
lateral distortion which often accompanies cases 
of angular curvature. The same apparatus, with 
the addition of lateral bands passing from the 
crutch supports over the arc of curvature, affords 
an excellent support for lateral curvature of the 
spine. 



INDEX. 



A 

Atrophy. Simple 229 

Attitudes and Gestures 44 

Atresia ani 335 

Ankles,' weak 372 

B 

Brain, dropsy of. 144 

Breathing, the 44 

Bowels, closure of 335 

Bone diseases 358 

Burns 369 

Beef Tea, how to prepare 391 

C 

Crying', gesture and attitude 44 

Constipation 85 

Cholera Infantum 100 

Croup 130 

Convulsions 1S1 

Chorea, or St. Vitus Dance 206 

Children, still horn 11 

Child, dressing the 20 

Congestion of the brain 188 

Children, wasting disease of 220 

Cough, character of. 48 

Constitution the 49 

Colic, wind 65 

Countenance, the 41 

Child, washing the 18 

Circulation 49 

Cough, whooping 115 

Cataract, congenital 328 

• D 

Diagnosis of infantile diseases 40 

Digestive svstem 50 

Diabetes. . ." 83 

Diarrhea 94 

Diarrhea, chronic 250 

Dress, follies of. 307 

Deformities of children 313 

Disease, hip 353 

Diseases, bone 358 

Disease of glands 361 

Diet in health 374 

Diet in disease 381 

Diet in diarrhea 883 

Diet in vomiting 885 

Diet iii rickets 386 

Diet in mucous disease 887 

Diet in consumption 889 

Diet, vegetable 892 



Erysipelas 58 

Epilepsey 203 

Ears, sore 75 

Ear, inflammation of. 77 

Eve lids, closure of 320 

Eves, cross 324 

Eye lid, tumors of. 331 

Ears, foreign bodies in 306 

F 

Food after first teething 37 

Fever, scarlet 144 

Fingers, contraction of. 341 

Feet, club 344 

G 

Gums, red 72 

Gums, white 74 

Gestures and attitudes 44 

Gland disease 361 

H 

Hernia, umbilical 336 

Hernia, scrotal 338 

Hip disease 353 

J 
Jaundice 55 

K 
Knee, knock 350 

L. 

Lungs, inflammation of. 107 

Lock iaw 198 

Lip, Hare 318 

Lips, closure of. 320 

Legs, bow 350 

M 

Mortality, infantile 7 

Milky scald 69 

Measles 159 

Mumps 104 

Mucous disease 284 

Mark, mothers' 333 

N 

Nursing 25 

Nursery 81 

Night terrors 218 

Nourishment insufficient 229 

Nevus, or mothers' mark 333 

Navel] tumor of 336 



404 



INDEX. 



O 
Ottorrhea 77 

P 

Paralysis, infantile 212 

Pox. small 169 

Palate-, cleft 315 

Phimosis 340 

Polypi 363 

R 

Rashes, tooth 71 

Rickets 271 

Rupture 333 

Ranula, or tumor under the tongue. 365 

S 

Still horn children 11 

Skin and features 42 

Sleep 53 

Scrofula 299 

Sexes, evils pertaining to 307 

Surgical diseases 313 

Speech, impediments of 322 

Strabismus, cross eves 324 

Stves and tumors of the eve 33: 

Scalds " 369 

Splints and mechanical appliances. 393 



T 

Tooth rushes 71 

Teething 33 

Thrush 61 

Tetanus, or lock jaw 198 

Tubercular diseases 2j9 

Tongue tie 314 

Tonsils, enlargement of 364 

Tongue, tumor under 365 

U 
Urine, inability to retain 80 

V 

Vomiting 87 

Varioloid 167 

Vaccination 176 

Vomiting, chronic 264 

Vulvae 320 

W 

Weaning 23 

Whooping cough 115 

Worms. 289 



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TO 



Health, Peace and Competence: 

OR 

THE ROAD TO HAPPY OLD AGE. 

A HAND BOOK, adapted to all classes, in all Darts of Hie Country. 
BY W. W. HALL, M. D., New York, 

Author of " Health by Good Living," " Fun Better than Physic," 
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[407] 



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[409] 



As this is a First Class, Standard Work, 

\Ye employ none but good, experienced Agents to canvass 
for it, or those of good address, energy and good character, 
and would prefer corresponding recommendations, with ap- 
plication. Applicants should state experience, territory de- 
sired, &c. 

Agents can engage in no more humane or philanthropic 
work, than in circulating this good book, for it not only 
shows how to prevent disease, but thfc folly and danger of 
Self Medication* by following the prescriptions of many 
of the " Medical "Works" throughout the country ; at the 
same time not understanding the nature of the complaint. 
No family should be without it, for they can save thrice the 
cost each year, if its injunctions are heeded. 



"We are often in receipt of orders where we have no 
Agents, as follows : 

" Office of the Thomas Clock Co., Thomaston, Ct. 
Gentlemen : — Enclosed find §12, for two copies Hall's 
'Guide Board.' Send by express. Yours truly, 

A. THOMAS." 

Anchor Works, Camden, lie. 
Gentlemen : — Enclosed find $4, for which please send us 
the ' Guide Board.' 

H. E. & W. G. ALDEN." 

Lasalle, III. 
Gentlemen : — I enclose you P. 0. money order for $6. 
Please send to my address, as good a bound volume of the 
-Guide Board ' as the money will pay for. 

Yours respectfully, 
II. B. CHAPMAN. 
[410] 



TMSTIMQMTAItB, 



Dr. Hall possesses many claims to the notice and respect of an 
intelligent, moral and virtuous community. He is handsome, 
learned, wise, industrious, practical, zealous in well doing, and has 

BUILT A WORK WORTHY THE STUDY AND ADMIRATION of the WOrld. 

City Items, Philadelphia. 

The " Guide Board " is Dr. Hall's largest work, and is thoroughly 
characteristic of the man. It treats of almost every subject liable 
to arise for consideration in the home, bearing upon the well-being 
and happiness of all. We commend the book to the careful study 
of all parents. — Rural New Yorker. 

"We can imagine it popular with the great mass of readers, who 
like to have, in bulk as well as in quality, the worth of their money. 
Every one may learn something from this volume about themselves 
— for there are few subjects pertaining to the human system which 
are not alluded to in it. — Evening Journal, Albany. 

A very useful and excellent book. — New York Independent. 

•We are certain that this work, if carefully read and its sugges- 
tions followed, would prevent at least one half of the pain and dis- 
ease suffered, or greatly ameliorate it. As friends of humanity, we 
call upon parents to place this book in the hands of their children, 
and to read it carefully themselves. The work contains over 750 
pages, and every page will add a week to every person's life, and a 
year to his happiness, if their injunctions are heeded. No work of 
the kind has sold as this is selling, and we believe that no similar 
work has the merit that this has. — Westfield Times. 

This is a royal octavo volume of 750 pages, and next to the Bible, 
is the most useful book that any family can possess. The author, 
eminent as the editor of that widely popular publication, "Hall's 
Journal of Health," is universally known as one of the best physi- 
cians in the country, and of no one are the writings and opinions on 
health so extensively quoted by the newspapers at large, and so 
conscientiously relied upon by the whole people as are those of Dr. 
Hall. "The Guide Board to Health " is his largest work, and is 
the most complete and searching of its kind that for family use ever 
issued from the press of any country. It is so plain that all can 
understand it, being free from medical terms; it exposes humbugs, 
condemns quackery, and is a book that is endorsed by the best and 
most learned men of the country. As a medical friend and adviser 
it is invaluable, saving its cost many times during the year by giv- 
ing information that otherwise would necessitate the expense of 
calling a physician. — Daily Union, Springfield, Mass. 
[411] 



TESTIMOmAm, 



The " Guide Board " is beautifully bound and printed. The sub- 
ject is treated in an instructive, practical and entertaining manner, 
and we predict for the work a wide circulation. — Herkimer County 
News. 

There is no doubt but that Dr Hall is, in his way, a benefactor to 
his kind, and that his books have helped many people to get into a 
simple, regular, healthy way of living, which has prolonged their 
lives and made them happier. We take pleasure in directing the 
attention of our readers to his largest work, which we have this 
moment received from the enterprising publishers. The " Guide 
Board " is just the book to take up at brief periods of leisure, and 
the writer's ideas are so directly and pertinently expressed, that 
they will leave an impression on the reader's mind. It has a wide 
scope, and embodies much information, aside from the expressed 
opinions of the author. It is copiously indexed, so that, as a fa- 
miliar hand-book, its suggestions are readily available. — Evening 
Gazette, Worcester, Mass. 

The "Guide Board " will be of great service to every household. — 
Watchman and Reflector. 

The " Guide Board " is for the benefit of the world, and adapted 
to every class. We have not space to do justice to the work. It 
is destined to have an extensive circulation. — Taunton Gazette. 

The man or woman who reads this volume and abides by the re- 
quirements cited as necessary to the conditions of a normal exist- 
ence, may feel certain of possessing the inestimable boon of health. 

Northampton Press. 

The " Guide Board" ought to be circulated far and wide. — New 
York Observer. 

Seven of the Best Physicians in Saginaw City, Michigan, sub- 
scribed for this work and cordially recommended "all to read, 
know and practice the teachings of this most excellent book." 

Dr. Hempel, of Michigan, says: "I feel justified in recom- 
mending ' The Guide Board to Health ' to my friends and all 
families who feel interested in the welfare of the rising generation. 
It will be found an admirable, convenient and useful acquisition to 
every family." 

It is a finely executed and valuable work, containing a vast 
amount of common sense. — Western New Yorker. 
[412] 



A FEW WORDS 

Frem Soma of ©if Bsperie&ced Ag©it§ B 



I have read the Guide Board with much benefit to myself, and 
was induced to apply to the Publishers to be constituted Agent for 
its sale in Boston. Among my patrons are the State and City 
Officials, Members of Congress, Bank Presidents, and other leading 
citizens, having sold to the Shoe and Leather Dealers alone, 130 
copies. B. H. SKINNER, Boston. 

Gentlemen : — I am meeting with very good success in my can- 
vass for the " Guide Board," and feel that I am engaged in a very 
good work, as I frequently hear from my patrons remarks which are 
very encouraging, such as — "You are not only benefiting yourself, 
but the community in general by circulating such a valuable Book." 
" Every wife and mother who neglects reading it, does herself 
and family injustice." "Although we see Agents every day, we 
have never had a work of equal value offered us." 

Next to the Bible, I value the Guide Board above all other 
books. 

Respectfully, F. J. GARDNER, Gloucester, Mass. 

S. E. Goodwin, our Agent in New Haven, Conn., writes : "My 
list is rapidly increasing. I am often told that, ' though your list is 
not as large as some we have seen in this place, yet it embraces 
more of our best and most noted citizens, than any we have ever 
helped to increase.' I have canvassed for many books, but none 
have given my patrons and myself so much satisfaction as the 
'Guide Board.'" 

(From the Rev. L. W. Ham, Agent for Bristol County, Mass.) 
Gentlemen: — I find "Dr. Hall's Guide Board" the best sell- 
ing Book I ever sold, and I have had six years' experience in sell- 
ing many other works. In a short time I sold 15(5 copies in New 
Bedford ; thirteen physicians subscribed, paid for, and recommend 
the work ; six of the clergymen, and many other of the leading citi- 
zens, were among my patrons. I find Dr Hall so popular and 
widely known, that I often take orders as soon as the title page and 
name of the Author are mentioned, without an examination of the 
work. Patrons often have remarked to me, " I would not part with 
it at any price " — " I am only glad to get that book" — " It is worth 
dollars to any family" — "Dr. Hall is sensible" — " He believes in 
common sense." It is gratifying to me to be able to present so val- 
uable a work to the public, and I hope to be able to continue in well 
doing. 

[413] 



WORDS FROM AGENTS. —Continued. 

Gentlemen : — I have already delivered several hundred copies 
of the " Guide Board," and many of my patrons are enthusiastic in 
its praise. One says, "It is worth its -weight in gold ; " another, 
" There is more sense on one leaf than in any other book I ever 
saw ; " and still another, who owns one of the largest libraries in 
the State, says, " I would not exchange it for any book I have in 
my whole library." I find very few among the more educated who 
are not more or less familiar with the writings of Dr. Hall, and this 
makes it much easier for the Agent to sell this, his largest work. 
F. L. CHILDS, Agent, Grand Rapids, Mich. 

(From Dr. S. C. "Whitney, Agent for Tioga County, N. Y.) 
"I have sold and delivered a large number of the "Guide 
Board," and still selling. Those to whom I have delivered are 
more than satisfied, and would not be deprived of the Avork for sev- 
eral times its cost." 

Alleghant River, Pa. 
Gentlemen : — I am selling Dr. Hall's Guide Board in Oil Terri- 
tory, where they have flowing wells, but as a general thing have to 
pump the oil ; so I expected to have to apply the pumping appara- 
tus, to obtain a subscriber; but I find I have struck a, flowing well. 
I have only to inform patrons who the author is, and men have run 
out bare-headed, stopping me in the street, to inquire if I was the 
Agent that was selling Dr. Hall's work on health; if so, they wanted 
a copy. I have had ladies say to me, that their husbands, who 
scarcely ever read much in a book, would take up this work, and 
" hang on to it," until late bed time. I have been engaged in this 
business for many years, and I find it the best selling book I 
ever canvassed for. E. DRAPER, 

Agent for Oil Creek and Alleghany River. 

Rockport, Howard Co., Mo. 
Gentlemen : — This is written to state that I have been canvassing 
in this section for the " Guide Board," and shall continue as long 
as I can make it profitable. I wish for 40 copies. Please send by 
whatever conveyance you deem most safe and convenient. En- 
closed find draft. Truly Yours. 

A. STEVENSON. 

Newburgh, N. Y. 
Gentlemen : I have sold a great many books, but have never had 
any to take as well as the " Guide Board." My patrons, who are 
among the most influential in all professions and avocations, are 
much delighted with it, and I have delivered nearly 200 copies al- 
ready. Next to the Bible, it is the lest book ever published. 

CHARLES SMITH. 
(414) 



WORDS FROM AGENTS.— Continued. 



Lowell, Massachusetts. 
Gentlemen: — I know of no work akin to the " Guide Board," 
held in so general and high estimation for practical worth, by its 
readers. My list of over 700, obtained in a portion of the business 
Bection of this city, includes prominent and influential men, in all 
professions and avocations. Seventeen of the practicing Physi- 
cians have purchased it, and all agree that it cannot fail to be of 
great practical good to all who read and study it. 

Yours Respectfully, J. F. DODGE. 



Westboro', Massachusetts. 
Gentlemen : — Yours of the 27th came duly at hand, and contents 
noted. I must say I like your style of correspondence. There is 
not so much of the " puff and blow " about it as a great many of the 
publishers of the present day choose to use. I have been watching 
for a long time for a work that I thought a man need not be 
ashamed to offer to the public, and I think your " Guide Board " 
is the one — coming, as it does, from an Author of experience and 
well known. I often receive letters from publishers offering 
" Splendid Inducements," but many of the works do not come up 
to what the people wish. After five years' experience, I find 
most of them want something practical, substantial and useful. 
Enclosed find P. O. money order for the Prospectus and one copy 
of the Library Binding. I can devote the whole of my time to this 
business. Yours Respectfully, 

L. M. ELLIS. 



Mr. J. T. French, our Agent at Madison, Wis., says : " Those 
who have become familiar with subscription lists inform me they 
have never seen a better list, with one exception. I like the 
'GdlDE Board,' as it is appreciated by a class of people with 
whom I like to do business. Your proposed allowance for damage 
on books is quite satisfactory, for which please accept thanks." 

There is no town in the West, however small, that the reputation 
of Dr. Hall has not reached. And when the "Guide Board" is 
mentioned, I often hear the expression, " That is the hook of all 
others I most want. I have not subscribed for 'a book for years, 
but Dr. Hall's Works are not to he resisted." I have never seen a 
subscriber dissatisfied with his investment. The superior manner 
of Binding elevates it at once above all ordinary subscription hookR, 
which is a source of pride to the Agents and satisfaction to the 
buyer. 

[415] 



liw Illustrated Edition. 



IPBOIAL HOTIOT. 



HAVING EXPENDED NEARLY 

FIFTEEN HUNDRED DOLLARS 

in procuring Electrotype Plates to illustrate 

TME QWIBE B&ABB, 

we shall now consider all territory as unCdflVClSSed, or 
the same as for a new work. Besides the Steel Plate 
Portrait of the Author, there are 

TUIFLTY-THREB 

ELEGANT FULL PAGE ILLUSTRATIONS, 

by the best Artists ?> on Fine Heavy Tinted Paper, adding 
much to the beauty and value of the book, and making it 
the most desirable, cheapest and best work ever published in 
this country. Though each copy, independent of the ex- 
pense of the electrotype plates, will cost 20 per cent, more 
than the former editions, we do not intend to raise the price 
of either style of binding, being satisfied that the illustra- 
tions will rapidly increase the sales. 

As the Guide Board has given universal satisfaction to 
all patrons, who are often recommending it to their neigh- 
bors, we think Agents can re-canvass some of their terri- 
tory and double their list of subscribers. 
[416] 



FAQTB FQE TME PWBM@, 



"We wish to call the attention of the Public to this 
Fact. "We use the very best material in all respects, and 
our books are bound in the most tasteful and substantial 
manner. We use the same paper in the Book, we do in 
the Prospectus ; some Publishers do not, thereby saving 
several hundred dollars in each edition. In the Gilt Edge, 
and in Lettering on Covers, we use the Pure Gold, " 18 
karats," while many use the Light Metal, which has a sil- 
very look, costing nothing, comparatively. 

With this Book we secure the services of First Class 
Agents and those of long experience, who well know and 
understand that a Good Standard Work has a long, 
steady sale, securing the class of patrons who always have 
funds on call, thereby losing no Subscribers. 

Agents who have sold our works exclusively for nearly 
six years, and are still selling, is a proof of the above, and 
an indication of their satisfaction with our dealings. One 
of the most noted men of this Republic says : " The Guide 
Board is, without doubt, far ahead of any subscription book 
yet published, and worth its weight in gold. The country 
is flooded with cheap, trashy subscription books, but this 
one, I am happy to state, is an exception. It is a solid book, 
full of choice, valuable information, and will save hundreds 
of dollars to the purchaser, and the Agent will reap a 
ricii Harvest." 

The 3Iilwaukee Sentinel says : " "We have seldom chroni- 
cled our opinion of a new book with more pleasure to our- 
selves, or with a greater certainty that we are doing the 
world at large a favor, than Ave do now in calling the atten- 
tion of our readers to the new and complete work of the 
celebrated Dr. Hall of New York. Every family would be 
healthier and happier for having read it. We believe its 
Sale will be Immense. 

[417] 



LIST 0F &LS3TEATI0IS 

IN THE 

O-TTIIDIE BOABD 



Page. 

1. Portrait of the Author. (Steel Plate) 

2. Health, Peace and Competence. Frontispiece . . 

3. Genius and Science 9 

4. The Most Efficient Exercise 22 

5. The Joking Clergyman 40 

6. The Little Courtesies of Life 70 

7. The Quaker and Thief 74 

8. Salt Lake Mail Party 109 

9. Effects of Imagination on Health 115 

10. Our Clergy Feasted too much 131 

11. The Knickerbocker and Yankee 165 

12. Prosperity the best Pill 183 

13. How to be Happy 186 

14. Mr. Income and Litte Tommy 199 

15. The Two Donkeys 213 

16. Martin Luther and his Three Frogs 214 

17. Queen Victoria and the Butcher's Daughter. .254 

18. Sowing Seed for a Harvest of Woe 275 

19. The Bulletin Board 297 

20. The Doctors who Attended Lazarus 314 

21 . Tomboys 331 

22. How to Make Home Happy 344 

23. Cold Water Mania 353 

24. Jack Tar and the Newspapers 391 

25. Riches and Poverty 437 

26. The Best Gymnasium 462 

27. Babies 489 

28. Farmers' Wives Overtaxed 525 

29. A Mother's Responsibility 533 

30. Poetry, Music and Health 540 

3 1 . Playing Cook 595 

32. Dirty Children 622 

33. Piazzas 681 

34. Growing Old Happily 747 

[418] 



A Hearty Laugh Elevates the Spirit and En- 
livens the Circulation." 



In Better thai Physic I 



EVEETBQBT-B MWM BME&EMYEMi 



W. W. HALL, M. D., 

' Health by Good Living," " Gi 
to Health, &c." 

I Vol. l2mo. pp.333. Price $1.50. 



Author of " Health by Good Living," " Guide Board 
to Health, &c." 



This Hook contains TWELVE HUNDRED MAXIMS in regard to 
HEALTH, MORALS, and HUMAN HAPPINESS. 

Is the Most Rapidly Selling Work on tie Continent. 

There is more sense, wit and fun in this book than any 
work published, and it is the best daily companion for the 
fireside and the traveler. 

D. E. FISK & CO., Publishers, 

Springfield, Mass. 



The American Bookseller's Guide says : " It is brimful of wis- 
dom, sportively disguised." 

" Let it circulate far and wide." — N. 0. Picayune. 

" In • Fun Better than Physic,' Dr. Hall has outdone himself." 

Springfield Telegram. 
" If the maxims in this hook were made rules of living, there 
would he 'Fun' in 'throwing Physic to the dogs." — Detroit Tribune. 
"We advise every family to send for it." — State Register, Iowa. 
"Excellent Hints." — Louisville Courier. 

"The world would he healthier and happier by following the 
maxims in this book." — X. }'. Tribune. 

For Sale in the Cars and by Canvassing Agents. Sent to any 

address, by Mail, post paid, on receipt of Price, where 

we have no Agent. 

[419] 



PlQTUBES FEQH THE PQETS, 

FROM THE BRUSH OF 

LOUIS A. ROBERTS : 

— AND— 

§g@rt im Brief Qh&pt@rsz 

FROM THE QUILL OP 

IKABOB IZAX. 

1 Vol., JJCedium Octavo, Fine Heavy Tinted Taper, Elegant Type, 

English STuslin, Bevel Boards, Gilt Back and Side Stamp. 

With 56 Elegant Full- Page Illustrations. 



This book contains some of the Finest Quotations from the 
most noted Poets, which are illustrated in a -unique and mirth- 
provoking manner. The Spicy, Sarcastic Chapters of Ikabod 
Izax show up the follies and foibles of everyday life, in a pleasing 
and agreeable manner, yet containing good solid advice to old and 
young of both sexes, in all classes of society. 

The chapters on "Ancient Marry-ners," "A "Woman Moved," 
"Tale Bearers," " Human Shoddy," and "Hogs," and the Amus- 
ing Illustrations of "Angelina Turning the Grindstone," the 
" Poor but Eespectable Parents," Whittier's " Maud Muller," 
(Raking Hay with a Mule,) and the Antediluvian Monkey recog- 
nizing "Darwin as his own Son," are worth double the price of 
the Book. 

ggp" As a Traveling and daily cheerful Fireside Companion it 
has no equal. 



PRICE, $1.50. 

Sold by Canvassing Agents, and all News Boys on the Trains, 
or sent to any address, post paid, (where we have no Agents) on 
receipt of price. 

D. E. FISK & CO., Publishers, 

SPRIXGFIELD, MASS. 

AGENTS WANTED. 

[420] 






9V 



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LIBRARY OF CONGRESS 

022 169 372 3 



